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A  NON- SURGICAL  TREATISE 


DISEASES  OF  THE 


PROSTATE  GLAND  AND  ADNEXA 


BY 

GEORGE  WHITFIELD  OVERALL,  A.  B.,  M.  D, 
CHICAGO 


EOWE   PUBLISHING  CO. 

1906. 


Copyright,   1906 

BV 

EOWE  PUBLISHING  CO. 


CONTENTS 


PAGE 

Introduction : 7 

Chapter  I. 

The  Non-Surgical  Treatment  of  Diseases  of  the  Prostate 

Gland  and  Adnexa 11 

Chapter  II. 

Acute  Prostatitis  21 

Chapter  III. 

Subacute  or  Chronic  Prostatitis 24 

Chapter  IV. 

Chronic  Congested  Enlargement  of  the  Prostate 75 

Chapter  V. 

Seminal  Vesicles 90 

Chapter  VI. 

Hypertrophy  of  the  Prostate 114 

Chapter  VII. 

Neuroses  of  the  Prostate 151 

APPENDIX 
Chapter  VIII. 

Electro-Physics,  Electrolysis  and  Cataphoresis 175 

Chapter  IX. 

Electro- Physics —  Continued 180 

Chapter  XX. 

High  Frequency  Current 208 


CLINICAL  CASES 


PAOB 

I.  Chronic  Prostatitis  and  Prostatic  Urethritis...     64 

II.     Chronic  Prostatitis  and  Stricture 66 

III.  Prostatitis    68 

IV.  Prostatitis  and  Epilepsy  69 

V.     Prostatitis,  Vesiculitis  and  Urethritis 71 

VI.    Prostatitis,  Vesiculitis  and  Urethritis 73 

VII.     Prostatic  Enlargement;   Melancholia 102 

VIII.  Prostatitis;    Vesiculitis;    Rectal   Ulcerations...  103 

IX.     Enlarged  Prostate,  Cystitis 105 

X.  Chronic    Enlarged    Prostate;    Vesiculitis;    Cys- 
titis     107 

XI.     Congested  Prostate;  Rheumatic  Arthritis 108 

XII.  Prostatitis;    Cystitis;   Rheumatic  Arthritis....  108 

XIII.  Prostatitis;   Prostatic  Calculi;   Cystitis 109 

XIV.  Prostatitis;  Cystitis;  Calculi  Ill 

XV.    Urethritis;  Sympexia;  Hemiparesis 112 

XVI.    Enlarged  Prostate;   Cystitis 113 

XVII.     Hypertrophy;    Catheter  Life 137 

XVIII.    Hypertrophy;    Cystitis;   Proctitis 138 

XIX.     Hypertrophy;   Cystitis   140 

XX.     Hypertrophy ;   Catheter   Life 141 

XXI.    Hypertrophy ;  Paroxysmal  Tenesmus 141 

XXII.     Syphilitic  Prostatitis   143 

XXIII.  Incontinence;  Paralysis 146 

XXIV.  Impotency;  Prostatitis  147 

'     XXV.    Chronic  Priapism ;   Prostatitis 148 

XXVI.     Chronic  Priapism 149 

XXVII.     Chronic  Priapism;  Prostatitis 149 

XXVIII.     Chronic  Prostatitis;   Melancholic  Mania 158 

XXIX.     Insomnia ;  Melancholia 160 

XXX.     Sciatica;    Spermatorrhea 164 

XXXI.    Impotency;  Pollutions   172 

XXXII.    Pollutions;  Prostatitis  172 

XXXIII.  Paresis;   Prostatitis 173 

XXXIV.  Hemiparesis;  Prostatitis 174 

XXXV.     Hemiparesis;    Prostatitis    175 

XXXVI.    Vesiculitis.  Metastasis 208 

XXXVII.    Cystitis,  Mctastatis 222 

XXXVIII.     Prostatic  Alescess,  Metastatis 225 

XXXIX.    Tumor  in  Bladder,  Hemorrhage 227 

iv 


ILLUSTRATIONS 


PAGE 

I.    Relation  of  the  prostate  to  the  bladder 12 

II.     Front  view  of   bladder,   urethra,   prostate,   Cow- 
per's  glands  and  openings  of  ejaculatory  ducts 

and  prostatic  ducts 14 

III.  Rear  view  of  the  same  organs 15 

IV.  The  mesenteric  and  solar  plexuses  of  nerves  sup- 

plying the   prostate,   bladder,   rectum,   kidneys 

and  bowels 17 

V.  The   spinal    nerves   distributed   to   the   perineum 

and  external  genitalia 18 

VI.     Subacute     or     chronic    prostatitis,     as     common 

among  young  men 25 

VII.     A  battery  and  cystoscope 46 

VIII.     Urethral  applicators  and  electrodes 53 

IX.     Urethral  applicators  and  electrodes 53 

X.     The  application  of  urethral  electrode 55 

XI.     The  application  of  cataphoresis   to  the  prostate 

through  the  rectum 57 

XII.     A   chronic   congested,   swollen   prostate,   as   com- 
mon among  middle-aged  men 76 

XIII.  Specimens  of  prostatic  concretions 87 

XIV.  Rectal  ulceration  as  due  to  chronic  prostatitis...  91 
XV.     The  position  of  the  kidneys 93 

XVI.     The   application   of   cataphoresis   to   the  vesicles 

through  the  rectum 98 

XVII.     Electrode  devised  by  the  author 101 

XVIII.     An  exaggerated  form   of  prostatitis-  complicated 

with  senile  hypertrophy 114 

XIX.     Enlarged  prostate  with  "third  lobe." 129 

XX.     Modification  of  the  Bottini  cautery 133 

XXI.     Application  of  the  cautery  to  the  indurated  third 

lobe  134 

XXII.     The  sciatic  nerve  and  its  branches  as  influenced 

by  prostatic  disease 163 

XXIII.  Bipolar  rectal  electrode 169 

XXIV.  Application  of  the  bipolar  electrode 170 

XXV.     Construction  of  a  faradic  battery 191 

XXVI.     Electro-physical  apparatus  and  wall  cabinet 206 

v 


PREFACE 

TO  THE  THIRD  EDITION. 


The  exhaustion  in  less  than  a  year  of  the  second  double 
edition  of  this  work,  the  flattering  criticisms  of  the  medical 
press,  and  the  almost  universal  commendations  of  the 
readers,  evinces  the  fact  that  the  little  book  has  filled  the 
void  for  which  it  was  intended ;  namely,  to  aid  the  general 
practitioner  as  well  as  the  specialist  in  the  non-operative 
treatment  of  all  those  chronic  diseases  of  the  urethra,  pros- 
tate, bladder,  vesicles,  kidneys,  and  their  complications; 
together  with  the  neurotic  and  metastatic  sequelae,  almost 
invariable  concomitant  therewith,  as  a  result  of  hidden 
gonococci  or  other  causes. 

Having  profited  by  the  numerous  letters  of  inquiry  from 
the  readers  of  the  former  editions,  I  have  endeavored  in 
revising  the  present  one  to  make  so  clear,  and  demonstrate 
so  thoroughly  my  methods,  that  most  any  intelligent  physi- 
cian may  be  enabled  to  successfully  carry  them  out,  pro- 
vided he  is  thoroughly  equipped,  conversant  with  the  im- 
plements and  has  thorough  knowledge  of  the  pathology 
and  complications  of  these  troubles.  While  simplicity, 
plain  illustrations  and  explicit  demonstrations  may  not  be 
necessary  for  some,  yet  there  are  many  others,  as  betokened 
by  their  letters,  who  require  such  explanation.  Thorough 
elucidation  and  demonstration,  even  to  the  point  of  sim- 
plicity, should  not  impugn  the  intelligence  of  any  physi- 
cian. 

There  has  not  been  a  year  during  the  past  twenty-five 
that  I  have  not  improved  my  methods  of  treatment  in 


PREFACE  TO  THIRD  EDITION. 

some  way  over  each  preceding  one ;  yet,  the  results  obtained 
of  late  in  the  diagnosis  and  non-operative  treatment  of 
these  troubles  justifies  the  statement  that  greater  strides 
have  been  made  during  the  past  year  than  for  many  years 
previously  thereto.  All  these  late  improved  methods,  to- 
gether with  the  older  ones,  are  thoroughly  elucidated  in 
this  edition. 

The  first  of  the  late  instruments  to  which  I  shall  call 
attention  is  one  especially  devised  for  the  general  practi- 
tioner, as  well  as  the  specialist ;  for  the  purpose  of  diagnos- 
ing and  treating,  in  the  simplest  manner  possible,  all  local- 
ized lesions  of  the  urethra,  from  the  meatus  to  the  prostate 
and  even  within  the  neck  of  the  bladder.  It  is  an  instru- 
ment that  is  less  complicated  and  can  be  manipulated  with 
greater  facility  and  less  local  disturbance  than  any  other 
equally  efficient  device.  While  I  have  several  urethral 
endoscopes  and  cystoscopes,  yet  I  use  this  instrument 
twenty  times  to  that  of  illumination  once.  I  have  never 
used  it  with  a  physician  or  in  the  presence  of  one,  that  he 
did  not  note  its  marked  simplicity  and  utility  and  ask 
where  he  could  procure  the  instrument.  In  fact,  many 
have  remarked,  "It  is  strange  it  has  not  been  thought  of 
before." 

When  properly  used,  and  with  a  specially  indicated  rem- 
edy, it  dispells  the  bete-noire  of  gleet,  as  it  enables  the 
physician  to  locate  the  seat  of  the  trouble  and  abate  it. 
In  connection  with  the  instrumental  treatment,  I  give  in 
detail  the  drugs,  together  with  their  different  strengths, 
which  I  have  found  by  experience  to  be  most  suitable  to 
individual  cases.  It  is  described  and  illustrated  on  pages 
following  64. 

My  second  equally  efficient  instrument  is  a  specially 
devised  mechanical  vibratory  massage  apparatus.  It  can 
best  be  appreciated  when  practically  demonstrated.  It  is 
especially  indicated  in  chronic  vesiculitis  and  prostatitis, 


PREFACE  TO  THIRD  EDITION. 

atony  of  the  bladder,  prostate  and  contiguous  organs.  It 
is  also  indispensable  in  impotency  that  persists  after  pros- 
tatitis and  vesiculitis  have  been  relieved.  While  it  is  a 
potent  agent  alone  in  the  treatment  of  these  troubles,  yet 
its  efficiency  can  be  greatly  enhanced  when  indicated  by 
connecting  thereto  a  specially  selected  electric  current; 
where  one  is  thoroughly  familiar  with  the  properties  of 
the  latter;  otherwise,  it  would  be  better  not  to  attempt 
their  conjoint  use.  Described  and  illustrated  on  pages 
following  102. 

The  third  is  a  thorough  delineation  of  my  method  of 
applying  the  electro-cautery  through  the  cystoscope  to  a 
tumor,  vegetative  growth,  or  rebellious  ulcer  at  or  around 
the  neck  of  the  bladder  or  prostate.  By  this  method,  one 
sees  what  he  is  doing  and  does  not  operate  blindly.  He 
can  remove  the  cautery  as  often  as  desired,  with  the  cysto- 
scope remaining  in  position,  and  note  the  result,  or  how 
much  has  been  accomplished  and  when  to  discontinue.  By 
this  method  there  is  absolutely  no  danger  of  hemorrhage, 
as  it  is  thoroughly  under  control  of  the  operator.  Secondly, 
in  those  cases  where  the  third  indurated  pathological  lobe, 
which  forms  at  the  neck  of  the  bladder,  serving  as  a  valve 
to  obstruct  the  outflow  of  urine,  can  be  removed,  unless  it 
has  become  too  large,  when  the  knife  alone  must  be  re- 
sorted to.  As  described  and  illustrated  on  pages  following 
136. 

Fourth,  a  more  thorough  explanation  of  the  uses  of  the 
high  frequency  current  in  the  treatment  of  these  troubles 
with  my  specially  devised  instruments  and  apparati.  In 
this  current  we  have  an  agent  the  properties  of  which  are 
inestimable  in  allaying  acute  inflammation  and  irritation; 
and  is  a  positive  and  harmless  germicide,  especially  indi- 
cated where  the  micro-organisms  are  deepseated  and  out 
of  reach  of  ordinary  lethal  agents. 


PREFACE  TO  THIRD  EDITION. 

In  the  second  or  last  edition  of  the  book  I  made  only 
brief  reference  to  the  uses  of  this  current  up  to  that  time. 
Since  then  I  have  had  more  extensive  experience  and  have 
noted  more  carefully  the  use  of  this  current,  not  only  in 
the  relief  of  pain,  the  diminishing  of  congestion,  and  allay- 
ing of  nervous  irritation,  but  I  have  carefully  investigated 
its  bactericidal  properties.  These  latter  are  indisputable, 
not  only  with  reference  to  the  treatment  of  these  diseases, 
but  they  have  been  reported  extensively  by  other  operators, 
and  the  germicidal  properties  are  now  too  well  established 
for  refutation.  In  fact,  the  observance  of  this  has  been 
so  noted  in  European  countries,  Germany  more  especially, 

that  many  have  gone  so  far  as  to  make  claim  that  it  is 
destructive  to  spermatozoa,  and  precautions  have  been 
established  in  many  hospitals  as  a  preventative  of  this.  It 
is  believed  by  some  that  its  effect  in  this  direction  is  per- 
manent, and  men  are  rendered  sterile  thereby.  My  own 
investigation  along  this  line  during  the  past  year  has 
demonstrated  that  it  is  only  temporary  in  its  effect,  and 
that  the  germs  become  permanently  inactive  and  cadaverous 
more  from  the  diseased  condition  of  the  gland  than  from 
the  effect  of  the  current.  Other  observers  along  this  line 
corroborate  this  view. 

I  wish  to  add  just  one  word  of  caution  regarding  the 
uses  of  the  different  electric  currents.  While  there  are  no 
more  efficient  auxiliary  remedies  in  the  whole  range  of 
therapeutic  agents  in  the  hands  of  those  thoroughly 
familiar  with  their  properties,  yet  to  one  not  so  versed  it 
is  better  to  leave  them  alone.  At  times  a  novice  may  make 
some  most  'Tiappy  hits,"  to  be  followed,  probably  in  the 
next  case,  by  irreparable  damage. 

The  late  Prof.  S.  W.  Gross,  a  most  talented  G.  U. 
surgeon,  in  his  work  on  Sexual  Diseases  of  Men,  pages  57 
and  58,  lauds  highly  both  galvanism  and  faradism  in  these 
chronic  troubles ;  but  mentions  a  case  of  superation  of  the 
testicles,  terminating  seriously,  from  injudicious  galvanic 
treatment. 

Ultzman,  one  of  the  leading  G.  F.  specialists  of  Ger- 
many, also  commends  in  high  terms  the  use  of  these  cur- 

ix 


PREFACE  TO  THIRD  EDITION. 

rents  in  the  treatment  of  these  diseases.  He,  too,  cautions 
the  inexperienced  in  their  use,  as  much  harm  may  result 
therefrom. 

I  do  not  wish  to  be  understood  as'  condemning  the  use 
of  the  knife  in  all  cases  and  under  all  circumstances,  for 
such  is  not  the  fact,  as  there  are  many  cases  where  the 
knife  is  indispensable;  but  what  I  do  claim,  and,  in  fact, 
am  corroborated  in  this  view  by  many  of  the  most  expe- 
rienced and  conservative  surgeons  of  today,  is,  that  the 
reckless  use  of  the  knife  is  resorted  to  much  too  often.  I 
was  much  gratified  in  noting  in  the  late  edition  (1905)  of 
Prof.  Keyes,  in  my  opinion  the  leading  G.  U.  surgeon  of 
America  if  not  in  the  world,  where  he  comes  out  boldly  in 
condemning  too  frequent  operations  and  the  too  frequent 
use  of  instruments.  I  have  been  alone  in  fighting  this 
barbaric  instrumentation  for  the  past  twenty-five  years, 
claiming  it  to  be  unscientific  and  capable  of  exerting  much 
harm,  especially  in  the  deep  urethra  and  upon  the  prostate 
and  neck  of  the  bladder;  more  especially  in  the  hands  of 
inexperienced  operators. 

Dr.  Keyes,  like  myself,  must  have  observed  many  cases 
of  irreparable  damage  to  have  brought  forth  the  following 
statement :  • 

(Page  288,  1905.)  He  says:  "Twenty  years  ago  no  one 
operated  upon  the  hypertrophied  prostate.  Today  every 
surgeon  approaches  this  organ  with  a  knife  or  a  cautery  in 
his  mind  if  not  in  his  hand.  The  mass  of  literature  upon 
this  subject  is  appalling.  Every  one  operates ;  every  one 
writes;  every  one  defends  his  own  views  in  his  own  way, 
and  the  result  is  that  the  varietv  of  operations  almost 
equals  the  number  of  operators.  *  *  *  On  one  point 
only  do  they  all  agree  implicitly,  if  not  explicitly,  viz.,  the 
prostate  may  not  be  operated  upon  with  impunity."   *   *   * 

On  page  138  he  says:  "Harmful  Treatment. — Finally, 
I  have  found  certain  methods  of  treatment  harmful,  and 
as  several  of  them  are  constantly  employed,  I  venture  to 
record  my  objections.     *     *     * 

"1.  Sounds  and  dilators  I  object  to  absolutely.  The 
massage  and  pressure  of  these  instruments  are  beneficial  in 
chronic  anterior  urethritis  almost  always,  in  prostatic 
hyperesthesia  and  congestion  often,  in  simple  posterior 
urethritis  rarely,  in  gonorrheal  posterior  urethritis  never. 


PREFACE  TO  THIRD  EDITION. 

"2.  Urethroscopy  I  object  to  on  the  same  ground.  The 
mechanical  injury  wrought  by  these  instruments  outweighs 
all  the  benefits  they  bestow." 

I  could  quote  numerous  other  authorities  in  condemna- 
tion of  the  injudicious  use  of  the  knife  and  instrumenta- 
tion, but  deem  it  unnecessary  at  the  present  time  of  the 
reign  of  conservative  censure. 

During  the  past  decade  chemistry,  the  microscope  and 
germ  cultivation  have  incontestably  demonstrated  through- 
out the  world  the  formidable  character  of  the  latent  gono- 
cocci  in  perpetuating  various  chronic  troubles  of  obscure 
nature,  for  many  years  after  the  prime  infection.  The 
prostate  and  seminal  vesicles  being  their  most  common 
hiding  places,  are  inaccessible  to  all  other  means  known 
to  the  profession,  except  those  described  herein. 

While  most  all  the  instruments  and  modes  of  treatment 
described  in  the  book  can  be  used  independently  of  elec- 
tricity with  marked  benefit  and  even  to  cure  the  majority 
of  cases,  yet  with  one  thoroughly  conversant  with  the  uses 
of  the  different  electric  currents,  much  additional  benefit 
can  be  accomplished. 

There  is  a  debit  and  credit  system  to  all  treatment,  and 
one  should  endeavor  always  to  make  the  credit  prepon- 
derate over  the  debit  until  cure  is  effected.  In  the  use  of 
sounds,  dilators  and  endoscopes,  in  the  hands  of  the 
majority  of  physicians,  harm  preponderates  over  the  bene- 
fit. But  where  a  positive  diagnosis  is  requisite,  all  acute 
inflammation  should  be  allayed ;  then  the  cystoscope  can  be 
used  tvitli  impunity.  Gonorrheal  metastases  being  so  inti- 
mately associated  with  chronic  diseases  remote  from  the 
seat  of  infection  a  physician  is  not  justified  in  making  a 
diagnosis  until  he  has  examined  the  prostate  and  vesicles. 
Synovial  membranes,  sheaths  of  nerves,  and  serous  mem- 
branes are  especially  marked  for  gonorrheal  poison ;  al- 
though there  is  no  part,  from  the  top  of  the  head  to  the 
heel,  immune  to  its  ravages. 

Dr.  Clark,  of  ISTew  York,  in  a  recent  article  in  the 
New  York  Medical  Journal,  claims  that  gonococci  has 
invaded  practically  every  tissue  of  the  body  and  that  no 
class  of  society  is  free  from  it,  and  that  seventy-five  per 
cent  of  the  adult  male  are  affected.     He  also  holds  that 


PREFACE  TO  THIRD  EDITION. 

chronic  prostatitis,  sexual  neurasthenia  and  other  compli- 
cations result  from  this  infection.  In  comparison  to 
syphilis  he  places  gonorrhea  100  to  syphilis  1 — in  number 
and  gravity. 

I  have  recently  noticed  where  a  prominent  G.  TJ.  special- 
ist has  made  the  absurd  statement  that  10  per  cent  of  all 
cases  of  prostatic  enlargement  over  50  is  cancerous.  I 
wish  to  state  that  not  one-half  of  one  per  cent  of  cases  that 
come  under  my  observation  are  cancerous.  It  is,  in  my 
opinion,  as  I  have  stated  in  the  main  text  of  the  book, 
that  it  is  those  chronic  ulcerated  conditions  that  they  are 
unable  to  cure  that  are  diagnosed  either  cancerous  or 
tuberculous.  The  trouble  lies  in  their  being  unable  to 
reach  and  destroy  the  gonococci  concealed  within  the  pros- 
tate or  vesicles,  and  as  a  result  the  micro-organisms  con- 
tinue to  pour  out  their  poisonous  virus  into  the  gland  and 
prostatic  urethra,  perpetuating  the  inflammation  and  ulcer- 
ation simulating  cancer.  These  are  the  class  of  cases  that 
I  like  to  set  for  treatment. 

I  shall  state  in  this  connection  that  an  erroneous  impres- 
sion prevails  that  I  either  have  my  instruments  patented 
or  control  their  sale.  Thev  are  not  patented,  and  any  one  can 
make  or  have  them  made  as  well  as  myself.  I  had  some 
made  for  my  own  use  and  at  the  same  time  a  few  for 
others  of  mv  friends. 

While  I  have  not  one  dollar  of  interest  in  any  instrument 
house,  nor  do  I  get  one  dollar  of  percentage  for  a  single 
one  of  mv  instruments  sold,  yet  to  avoid  answering  the 
numerous  letters  of  inquiry  of,  "Who  makes  my  instru- 
ments?" I  embrace  the  opportunity  of  stating  here  that 
the  Betz  Co.,  Hammond,  Ind.,  make  them.  I  wish  also  to 
state  that  I  can  conscientiQusly  recommend  their _  Wall 
Plates,  as  I  have  of  late  made  a  thorough  examination  of 
them. 

In  conclusion,  I  beg  to  state  that  I  have  labored  hard 
and  earnestly  in  an  endeavor  to  master,  in  so  far  as  pos- 
sible, the  treatment  of  these  formidable  diseases  and  com- 
plications without  having  to  resort  to  the  knife.  I  have 
compiled,  in  this  little  volume,  the  results  of  more  than  a 
quarter  of  a  century's  work  for  the  benefit  of  the  profession 
directly,  and  the  numerous  sufferers  indirectly,  as  I  know 
of  their  manifold  transgressions. 


INTRODUCTION. '^^^J'   ''^^i 


In  presenting  this  book  to  the  profession,  the  author 
has,  by  avoiding  theoretical  discussion,  endeavored  to  give 
a  plain,  practical  and  concise  summary  of  the  methods  and 
results  of  the  non-surgical  treatment  of  Diseases  of  the 
Prostate  Gland  and  their  sequela?  as  demonstrated  by  more 
than  twenty  years  of  clinical  experience. 

Some  of  the  matter  contained  herein  has  heretofore 
appeared  in  the  "Mississippi  Valley  Medical  Journal"  of 
March,  1883,  and  August,  1887;  "Medical  Mirror"  of 
April,  1896,  and  the  "Journal  of  the  American  Medical 
Association"  of  January  21,  1899,  etc. 

A  little  over  a  quarter  of  a  century  ago  the  author 
completed  his  course  of  medical  instruction  under  two  of 
America's  greatest  surgeons,  viz..  Professors  S.  D.  G-ross 
and  Joseph  Pancoast.  The  teachings  in  vogue  at  that 
time  (and  there  has  begn  little  improvement  since)  re- 
garding the  treatment  of  prostatic  diseases  were  with 
sounds,  the  knife,  the  Bottini  cautery,  etc.  Having  fol- 
lowed the  teachings  of  these  eminent  surgeons  for  some 
years  thereafter  with  very  unsatisfactory  results,  I  began 
experimenting  with  local  and  constitutional  medication, 
electrolysis  and  cataphoresis,  with  varied  results.  At  times 
I  would  have  the  most  "Tiappy  hits,"  to  be  followed  by  an 
egregious  failure.  From  time  to  time  I  devised  and  per- 
fected instruments  with  which  to  apply  the  combine! 
properties  of  medicines,  electrolysis  and  cataphoresis  for 
the  purpose  of  stimulating  vaso-motor  contraction,  reliev- 


8  INTRODUCTION. 

« 
ing    thereby    congestion    and    inflammation,    dissipating 

morbid  tissue  and  chemically  decomposing  or  breaking  up 

lime  or  earthy  concretions   that  form  in  the  ducts  and 

follicles  of  the  prostate. 

I  do  not  wish  to  convey  the  idea  that  I  limit  the  treat- 
ment entirely  to  medicines,  electrolysis,  cataphoresis,  etc., 
as  there  are  some  few  eases  in  which  the  use  of  the 
knife  becomes  indispensable.  I  am  fully  aware  of  the 
incredulity  of  the  profession  regarding  electrolytic  treat- 
ment, since  electricity  has  been  so  long  in  the  hands  of 
empirics.  It  is  also  true  that  electricity,  like  most  potent 
therapeutic  remedies,  has  been  no  exception  to  the  rule  of 
having  had  over-enthusiastic  advocates  who,  at  first,  when 
its  principles  were  little  known,  and  before  it  had  been 
placed  upon  a  systematic  basis,  claimed  for  it  properties 
beyond  its  field  of  utility,  and  would  supplant  therefor 
every  other  mode  of  treatment. 

There  are  others  who,  from  lack  of  knowledge  of  the 
science  of  electricity  (due  to  the  fact  that  it  was  not  taught 
in  the  medical  colleges  at  the  time  they  graduated),  are 
prejudiced  against  its  use  in  any  form  or  for  any  purpose. 
They  are  content  to  grope  in  the  old,  beaten  path,  how- 
ever unsatisfactory  may  be  the  result. 

I  regret  to  have  to  state  that  the  large  majority  of 
works  published  upon  electro-therapeutics  are  based  upon 
theory  or  are  mere  compilations,  unreliable  in  their  teach- 
ings. Dr.  S.  H.  Morrell  in  the  "Times  and  Eegister," 
March  16,  1895,  on  "A  Plunge  into  Electro-therapeutics," 
gives  some  wholesome  advice  to  beginners,  which  thor- 
oughly accords  with  my  views.  He  says:  "If  you  wish 
to  acquire  skill  in  the  use  of  electricity,  don't  set  about  it 
alone  and  don't  rely  on  what  you  find  in  text  books.  If 
you  can  induce  a  reliable  expert  to  take  you  as  a  student 
for  a  few  months,  do  so,  no  matter  what  it  costs.     As 


INTRODUCTION.  9 

there  are  various  branches  of  electrical  work  in  which 
special  technique  is  employed,  for  instance,  in  genito- 
urinary and  gynecological  practice,  you  should  obtain  a 
short  course  of  practical  instruction  in  each.  When  you 
have  devoted  six  months  to  an  apprenticeship  of  this  kind 
you  will  have  laid  the  foundation  for  ultimate  success." 

While  the  use  of  electricity  is  harmless  in  the  hands  of 
competent  and  experienced  operators,  yet  I  have  seen  some 
serious  results  follow  its  application,  even  by  intelligent 
and  prominent  physicians  who  were  not  familiar  with  the 
principles  of  electro-physics  and  methods  of  electrolysis. 
It  requires  experience  and  tact  as  well  as  knowledge  to 
succeed  in  the  treatment  of  these  complicated  diseases, 
Just  as  it  does  in  any  other  line  of  special  practice. 

In  brief,  I  shall  state  that  after  many  years  of  research, 
I  have  been  enabled  to  devise  both  ways  and  means  by 
which  to  reach  directly  the  seat  of  the  disease. 

The  past  decade  has  been  made  memorable  by  the  stand 
taken  by  some  of  our  most  distinguished  medical  and 
surgical  teachers,  in  favor  of  conservatism  against  the 
indiscriminate  use  of  the  knife.  Prominent  among  these 
I  may  mention  the  venerable  Professor  A.  Jacobi  of  N"ew 
York,  one  of  the  most  profoundl}^  erudite  men  in  the 
medical  profession,  and  whose  experience  extends  over 
half  a  century  in  active  practice.  In  an  address  delivered 
by  him  at  the  International  Congress  at  Eome,  April  4, 
1894,  on  ^^Non-IsTocere"  (Do  no  harm),  he  said:  "The 
relative  impunity  of  operative  interference,  accomplished 
hy  modern  asepsis  and  antisepsis,  has  developed  an  undue 
tendency  to,  and  rashness  in,  handling  the  Tcnife.  The 
hands  take  too  frequently  the  place  of  brains.  Who  does 
not  Jcnow  that  the  alleged  safety  in  operating  tempts  some 
of  our  skilled  operators  and  the  credulous  public  into  use- 
less, or  even  contraindicated  procedure?" 


10  INTRODUCTION. 

In  the  dedicatory  address  delivered  in  the  Senn  Hall, 
December  17,  1902,  by  Sir  William  Hingston,  Professor 
of  Clinical  Surgery  at  Laval  University,  Montreal,  he  gave 
warning  that  the  surgeon's  knife  may  be  used  too  fre- 
quently. In  part  he  said:  "The  immunity  with  which 
the  most  formidable  operaiions  are  now  performed  has 
given  confidence — might  I  not  say  a  recklessness,  possibly 
— which  renders  the  staying  hand  of  the  physician  of 
priceless  value.  Especially  is  this  true  when,  as  it  some- 
times happens,  the  inexperienced  surgeon  hurriedly  resorts 
to  a  tentative  operation  to  establish  a  diagnosis  where  one 
more  experienced  would  see  no  reason  for  the  procedure. 
T  have  more  than  once  observed  the  meddlesomeness  of  a 
surgeon  to  he  in  direct  ratio  to  the  measure  of  his  inex- 
perience." 

Damage  once  done  to  the  prostate  by  the  knife  is  irre- 
parable. "Better  bear  the  ills  we  have  than  fly  to  those  we 
know  not  of." 

George  Whitfield  Overall. 
Chicago,  III.,  May,  1906. 


CHAPTER  I. 

THE     NON-SURGICAL     TREATMENT     OF     DISEASES     OF     THE 
PROSTATE   GLAND  AND  ADNEXA. 

Of  the  various  classes  of  diseases  from  which  men  suffer, 
none  is  of  more  frequent  occurrence,  none  has  more 
baffled  the  skill  of  the  physician,  or  tried  the  patience  of 
the  sufferer,  than  that  of  the  prostate.  The  frequency 
with  which  this  gland  is  affected  has  been  variously  esti- 
mated by  genito-urinary  specialists;  some  holding  that 
from  twenty-jfive  to  fifty  per  cent  of  men  suffer  from  its 
disease,  others  claiming  that  it  is  an  exception  to  find  a 
man  past  forty  with  a  healthy  prostate  gland. 

When  we  note  the  highly  sensitive  organization  of  the 
gland,  its  psycho-sexual  relation,  its  exposed  position  to 
the  bladder,  rectum  and  seminal  vesicles,  and  the  fact 
that  it  is  pierced  by  the  urethra  and  ejaculatory  ducts, 
and  that,  moreover,  it  is  frequently  subject  to  excessive 
tax  or  abuse,  we  cannot  wonder  at  the  frequent  functional 
or  organic  diseases  incident  thereto,  the  various  nervous 
disturbances  arising  therefrom,  and,  owing  to  its  inacces- 
sibility, the  obstacles  to  be  overcome  in  its  treatment. 

The  prostate  is  a  musculo-glandular  organ  enveloped  in 
a  fibrous  capsule.  It  is  situated  at  and  embraces  the  neck 
of  the  bladder.  It  is  about  the  size  and  shape  of  a  horse 
chestnut,  with  its  base  directed  towards  the  bladder  and 
its  apex  in  front.  It  lies  upon  the  rectum,  being  separated 
therefrom  only  by  loose  fascia.  Its  transverse  diameter  at 
the  base  measures  one  and  one-half  inches,  its  antero- 
posterior diameter  (which  corresponds  with  the  length  of 

11 


12 


PROSTATE  GLAND  AND  ADNEXA. 


the  prostatic  urethra)   is  one  and  one-quarter  inches,  and 
its  depth  three-quarters  of  an  inch. 

It  consists  of  two  lateral  lobes  of  equal  size.  Some 
writers  mention  a  third  or  middle  lobe,  but  this  is  re- 
garded by  most  authorities  (and  it  will  be  so  considered 
by  the  author)  only  as  a  pathological  condition.  The 
urethra  passes  through  the  anterior  third  of  the  gland, 
though  occasionally  the  posterior. 


Fig.  I. 


Fig.  I  shows  the  relation  of  the  prostate  to  the  bladder 
and  prostatic  urethra.  The  floor  of  the  latter  is  a  very 
complicated  and  highly  sensitive  structure  and  bears  an 
important  relation  to  the  gland,  both  from  a  functional 


ANATOMY  OF  THE  PROSTATE. 


13 


Fig.  II.  (R.  W.  Taylor.) 


14  PROSTATE  GLAND  AND  ADNEXA. 

and  pathological  viewpoint.  In  fact,  it  is  really  a  part 
of  the  prostate  itself. 

In  the  center  and  longitudinal  direction  of  the  floor  is 
a  small  eminence  (9),  the  verumontanum,  or  caput  galli- 
naginis.  Somewhat  in  front  and  in  the  middle  of  this 
eminence  is  a  small  cavity,  the  utricle  (11).  On  each 
side  there  is  a  slight  fossa,  into  which  the  ejaculatory  (10) 
and  prostatic    (12)   ducts  open. 

The  floor  of  the  prostatic  urethra  is  the  most  sensitive 
part  of  the  entire  genito-urinary  tract  and  is  considered 
the  seat  of  the  sexual  orgasm.  It  is  subject  to  pathological 
lesion  more  than  any  other  portion  of  the  urethral  canal, 
owing  to  its  complex  structure,  and  to  the  fact  that  it 
receives  the  irritative  secretions  of  the  prostate  and  semi- 
nal vesicles,  when  these  latter  organs  are  affected.  It  is, 
in  fact,  an  index  of  no  little  importance  to  the  condition 
of  the  prostate. 

The  orifices  of  the  ejaculatory  ducts  or  utricle  often 
become  dilated  when  disease  of  the  prostate  or  vesicles 
exists,  and  are  liable  to  engage  the  point  of  a  small  instru- 
ment, in  an  effort  to  force  an  entrance  into  the  bladder, 
and  becomes  arrested,  when  a  larger  instrument  will  pass 
over  these  orifices  and  enter  the  bladder  with  ease. 

Dr.  R.  W.  Taylor,  of  ISTew  York,  gives  two  excellent 
illustrations  of  these  organs  in  his  late  work  on  genito- 
urinary diseases. 

Fig.  II  gives  a  front  view,  showing  the  bladder  and 
urethra  opening  upon  the  front  surface :  1,  the  trigone 
and  orifices  of  the  ureters;  2,  prostate  and  prostatic 
urethra;  3,  bulb  of  the  urethra  with  opening  of  Cowper's 
glands;  4,  verumontanum  with  orifice  of  utricle;  5,  open- 
ings of  ejaculatory  ducts;  6  and  7,  openings  of  the  pros- 
tatic ducts. 


ANATOMY  OF  THE  PROSTATE. 


13 


Fig.    III.       (R.    W.    Taylor.) 


16  PROSTATE  GLAND  AND  ADNEXA. 

Fig.  Ill  gives  rear  view  of  the  same  organs :  1,  ureters ; 
3,  ampulla;  3,  seminal  vesicles;  4,  prostate;  5,  Cowper's 
glands;    6,  bulb  or  urethra;    7,  membranous  urethra. 

Beneath  the  fibrous  capsule  of  the  prostate  is  a  firm 
band  of  unstriped  muscular  fibers  surrounding  the  base 
of  the  organ  and  reflected  downwards  towards  the  apex. 
The  same  fibers  radiate  throughout  the  gland  in  the  form 
of  trabecule,  forming  meshes,  through  which  the  vessels 
and  nerves  ramify.  Interposed  between  these  meshes 
there  are  also  numerous  follicles  that  secrete  a  milk}^, 
alkaline  fluid,  which  passes  out  through  the  prostatic  ducts 
upon  the  floor  of  the  urethra. 

The  arteries  are  derived  from  the  internal  pudic,  vesicle 
and  hemorrhoidal,  which  are  branches  of  the  internal  iliac. 

The  veins  form  plexuses  around  the  base  and  sides  of 
the  prostate,  bladder  and  rectum,  communicating  freely 
with  the  hemorrhoidal,  spermatic,  dorsal  vein  of  the  penis 
and  pampiniform  plexus.  Thus  the  organs  from  which 
they  arise,  namely,  the  rectum,  spermatic  cord,  epididymis 
and  penis,  are  brought  into  close  physiological  and  patho- 
logical relations  with  the  prostate.  Passive  congestion  or 
stasis  of  the  veins  of  the  latter  cause  a  clogging  of  the 
veins  of  the  rectum  resulting  in  ulceration  or  hemorrhoids ; 
or,  when  the  spermatic  veins  are  involved,  varicocele 
follows. 

NERVES. 

The  nerves  supplying  the  prostate  are  very  numerous 
and  sensitive.  Those  derived  from  the  sympathetic  system 
are  supplied  by  the  hypogastric  and  pelvic  plexuses,  as 
illustrated  in  Fig.  IV. 

A  double  chain  of  sympathetic  fibers,  as  illustrated  by 
Fig.  IV,  connect  with  the  mesenteric,  renal  and  solar 
plexuses,    bringing    the    bowels,    kidneys     and     stomach 


ANATOMY  OF  THE  PROSTATE. 


17 


Pig.   IV.     (Quain.) 


18 


PROSTATE  GLAND  AND  ADNEXA. 


specially  into  intimate  relation  with  the  prostate  and  other 
pelvic  viscera. 

A  large  number  of  spinal  filaments,  arising  mostly  from 
the  sacral  plexus,  though  some  from  the  lumbar  spinal 
nerves,  are  distributed  to  the  prostate  and  adjacent  organs, 
and  communicate  freely  with  the  sympathetic.  Fibers 
of  the  latter  may  be  noted  by  reference  to  Fig.  IV,  as 
passing  to  the  great  sciatic  (cr')  nerve,  before  it  makes 
its  exit  through  the  sacro-sciatic  foramen  upon  the  hips. 


■^ 


Fig.    V.       (Hirschfeld    and    Leveille.) 

Fig.  V  shows  the  numerous  branches  of  the  spinal  nerves 
distributed  to  the  perineum  and  external  genitals,  which 
also  communicate  with  the  nerves  of  the  prostate  and 
pelvic  viscera. 

FUXCTIOX. 

The  prostate  is  an  important  genital  organ,  possessing 
the  triple  function:    a,  of  expulsion  of  semen  by  means 


FUNCTION.  IS 

of  the  rhythmical  contraction  of  its  muscular  fibers ;  b,  of 
being  the  nerve  center  of  the  orgasm;  c,  of  secreting, 
through  its  glandular  structure,  a  fluid  essential  as  a 
vitalizing  agent  to  the  spermatic  germs. 

It  is  in  this  gland  that  the  pleasurable  sensation  of  the 
orgasm  is  located;  the  sensation  being  synchronous  with 
the  expulsion  of  semen.  It  is  by  this  gland  that  the 
physiological  impulse  to  gratify  animal  nature  is  indi- 
rectly exerted  through  the  sympathetic  and  cerebro-spinal 
nerve  centers.  In  fact,  the  gland  has  been  appropriately 
called  the  seat  of  the  sexual  brain.  The  intimate  recipro- 
cal relations  of  the  cerebro-spinal  centers  and  the  prostate 
are  very  marked,  both  in  health  and  disease. 

In  health,  excessive  mental  exertion,  as  by  close  study 
or  business  cares,  will  lessen  the  sexual  appetite;  while 
violent  emotions,  as  grief,  fright  or  anxiety,  will  tem- 
porarily suspend  all  desire. 

Men  are  by  nature  much  more  sensually  inclined  than 
women;  and  when  they  cultivate  libidinous  impulses,  and 
associate  with  prostitutes,  are  liable  to  indulge  their  sex- 
ual propensities  to  such  an  extent  as  to  develop  passions 
that  may  lead  to  grave  moral  vices,  like  excessive  inter- 
course or  masturbation,  resulting  in  lesions  of  the  prostate, 
or  some  form  of  nervous  disease. 

Just  as  mental  disturbances  influence  sexual  conditions, 
so  in  like  manner  do  diseases  of  the  prostate  gland  cause 
such  various  forms  of  mental  disorders  as  inactivity,  de- 
pression and  numerous  other  neurotic  aberrations. 

I  have  especially  noticed  that  men  between  the  ages  of 
forty  and  seventy,  suffering  from  chronic  prostatitis  lose 
the  keen  mental  activity  they  formerly  possessed.  Their 
perceptive  and  reasoning  faculties  become  sluggish  and 
inactive. 

Owing  to  the  contiguous  relations,  the  direct  source  of 


20  PROSTATE  GLAND  AND  ADNEXA. 

blood  supply,  and  the  intimate  connection  of  the  nerves  of 
the  prostate,  bladder,  seminal  vesicles  and  rectum,  disease 
of  the  prostate  cannot  exist  any  great  length  of  time  with- 
out causing  either  functional  disturbance  or  organic  dis- 
ease of  the  others.  Besides,  inflammatory  disease  of  the 
prostate  often  arises  from  chronic  rectal  troubles. 


Engorgement  of  Portal  Veins  and  Pampiniform  Plexus. 
( Semi-diaoramatic. ) 

A.  Aff^endix  lermiformis.  B.  Urinary  Bladder.  C.  Colon- 
Ascending.  C^.  Coloji— Descending.  I.  Small  Intestine.  L.  Liver 
and  Gall  Bladder.  P.  Pancreas.  R.  Rectum.  S.  Stomach. 
T.    Testicle . 


In  addition  to  an  involvement  of  the  various  important 
nerves  and  plexuses  of  nerves,  both  of  the  cerebrospinal 
and  sympathetic  nervous  systems  heretofore  illustrated, 
there  is  also  a  clogging  or  congestion  of  the  veins  of  this 
region,  especially  those  of  the  pampiniform  plexus,  as  a 
result  of  engorgement  of  the  veins  of  the  prostate,  bladder, 
and  rectum. 

Plate  Via  illustrates  these  veins  in  a  congested  state  of 
enlargement,  or  turgescence. 

The  veins  of  the  bladder,  bowels,  testicles  and  prostate 
being  so  closely  connected  that  the  clogging  of  one  neces- 
sarily involves  the  others,  and  so  dams  up  the  blood  cur- 
rent as  to  affect  many  of  the  abdominal  organs ;  hence,  you 
have  as  a  result,  congested  enlargement  or  engorgement  of 
the  hemorrhoidal,  the  spermatic,  portal  and  hepatic  veins. 
As  a  result  of  this  engorgement,  there  follows  torpid  liver, 
disturbed  stomach,  at  times  gaseous  eructations  and  other 
times  an  acid,  nervous  form  of  indigestion.  The  bowels, 
too,  become  sluggish  with  gaseous  accumulations  in  colon 
and  even  small  bowels.  These  organs  are  so  closely  re- 
lated to  one  another  that  trouble  arising  in  one  is  readily 
transmitted  to  others. 

Perverted  function  of  the  liver  is  especially  noticeable 
in  disease  of  the  prostate.  Physicians  writing  upon  this 
subject  have  noted  that  the  liver  has  the  property  of  con- 
verting uric  acid  into  soluble  urea;  but  when  it  becomes 
congested  indirectly  from  long  standing  prostatitis,  uric 
acid  crystals  accumulate  in  the  gall  bladder,  causing  dull 
pain  in  that  region,  or  under  the  lower  ribs  on  the  right 
side.  The  bowels,  too,  become  sluggish,  necessitating  the 
constant  use  of  some  medicine.  The  stomach  is  almost 
invariably  involved  in  sympathetic  relation  and  it  is  dosed 
ad  nauseum,  when,  in  fact,  there  is  nothing  directly  the 
matter  with  it.  When  the  physician  locates  and  removes 
the  cause  of  the  trouble,  the  patient  does  not  know  he  has 
a  stomach.  Functional  disturbance  of  the  heart  is  not 
infrequent  from  the  same  sluggish,  inactive  condition  of 
liver,  stomach  and  bowels,  superinduced  by  the  prostate 
and  bladder  as  prime  offender. 

20a 


PEOSTATIC    DISEASES. 

Diseases  of  the  prostate  gland  will  be  considered  under 
the  following  heads : 

ACUTE  PROSTATITIS. 

SUBACUTE  OR  CHRONIC  PROSTATITIS. 

CONGESTED^  ENLARGED  PROSTATITIS. 

SENILE    HYPERTROPHY. 

TUBERCULAR   AND    SYPHILITIC    PROSTATITIS. 

NEUROSES   OF   THE  PROSTATE. 


CHAPTEE   II. 

ACUTE   PROSTATITIS. 

This  form  of  disease  of  the  gland  usually  results  from 
harsh  treatment  of  gonorrhea,  by  means  of  strong  injec- 
tions, large  doses  of  copaiba,  turpentine  or  cantharides,  or 
from  injudicious  use  of  instruments.  The  gland  swells 
very  rapidly  and  is  extremely  painful.  The  inflammatory 
condition  usually  extends  to  the  seminal  vesicles,  bladder 
and  entire  pelvic  viscera,  giving  rise  to  marked  pain  in  the 
region  of  the  perineum,  rectum  and  groins. 

Dysuria  is  excessive  and  is  often  attended  with  incessant 
tenesmus.  The  attack  is  usually  ushered  in  with  a  chill, 
which  is  followed  by  njild  pyrexia.  The  desire  to  void 
urine  is  frequent  and  uncontrollable,  the  patient  passing 
but  a  small  quantity  at  a  time.     The  irritation  is  often 

«  21 


22  PROSTATE  GLAND  AND  ADNEXA. 

transmitted  to  the  rectum,  giving  rise  to  a  sensation  of 
fullness,  and  a  desire  to  remain  at  stool.  The  latter  symp- 
tom is  especially  prominent  when  vesiculitis  coexists. 
Orchitis  often  supervenes  which  greatly  increases  the  dis- 
comfort of  the  patient. 

Treatment. — The  treatment  consists  mainly  in  pallia- 
tive measures,  by  way  of  rest  in  bed,  anodynes  in  the  form 
of  hyoscyajnus,  opiates  and  hot  hip  baths.  The  diet  should 
be  light  and  consist  mostly  of  demulcents,  as  of  barley 
water,  which  is  especially  indicated ;  soups  and  other  light 
nourishment.  All  injections  or  specific  medication  should 
be  discontinued. 

Urethral  instrumentation  is  strictly  interdicted,  unless 
there  are  indications  of  retention  of  urine.  Should  it  be 
necessary  to  evacuate  the  bladder  by  catheter,  which  is 
exceedingly  rare,  a  full  dose  of  morphia  should  be  admin- 
istered half  an  hour  previously  thereto.  Eectal  supposi- 
tories of  boric  acid,  belladonna  and  opium  give  great  relief. 
The  bowels  should  be  maintained  in  a  laxed  condition  by 
means  of  saline  cathartics. 

In  from  five  to  fifteen  days  the  urethral  discharge  is 
re-established,  unless  complicated  with  orchitis,  and  gen- 
erally becomes  quite  profuse.  This  is  followed  by  defer- 
vescence and  the  subsidence  of  all  acute  symptoms.  At 
this  stage  I  advise  the  free  use  of  a  five  per  cent  solution 
argyrol  in  distilled  water,  to  be  injected  deeply  into 
the  urethra,  from  four  to  five  times  daily,  with  an 
ordinary  large  sized  gonorrheal  syringe  having  a  blunt 
point.  I  never  advise  a  long  nozzled  syringe,  as  it  often 
serves  to  perpetuate  urethritis  near  the  meatus.  This 
treatment  readily  relieves  all  acute  symptoms. 

Should  the  discharge  continue  excessively  and  longer 
than  a  week,  after  the  subsidence  of  acute  symptoms,  I 


ACUTE  PROSTATITIS.  23 

add  one  grain  of  sulpho-carbolate  of  zinc  to  the  ounce  of 
the  injection  before  mentioned. 

When  complicated  by  orchitis,  rest  in  bed  is  imperative. 
Local  applications  of  belladonna  and  hamamelis  with  cold 
applications  to  the  swollen  testicle  give  relief.  Anodynes 
internally  should  be  the  chief  remedies. 

All  acute  symptoms  gradually  subside  under  this  treat- 
ment, leaving  a  chronic  gleety  discharge,  which  is  a  "flag" 
to  indicate  chronic  inflammation  of  the  prostate  or  vesicles, 
and  will  be  considered  in  the  succeeding  chapter. 


CHAPTER   III. 

SUBACUTE  OR  CHRONIC  PROSTATITIS. 

This  affection  of  the  gland  is  one  of  the  most  common 
diseases  with  which  young  men  between  the  ages  of  twenty 
and  thirty-five  suffer.  It  is  quite  distinct  from  chronic 
congested  enlargement,  common  to  men  of  middle  age,  and 
from  senile  hypertrophy.  A  strict  boundary  line,  however, 
cannot  be  drawn,  with  reference  to  age,  in  any  class  of 
diseases  of  the  prostate.  There  are  occasionally  cases  of 
chronic  prostatitis  that  occur  earlier  than  the  twentieth 
year,  while  others  are  met  with  even  past  thirty-five  with- 
out there  being  any  perceptible  enlargement  of  the  gland. 

Fig.  VII  illustrates  this  form  of  disease:  the  red  parts 
indicating  the  sites  of  the  lesions.  In  the  earlier  stages 
of  the  trouble  the  inflammatory  condition  is  confined  to 
the  ducts  and  follicles  of  the  gland,  but  when  of  long 
standing  it  becomes  diffused  and  involves  the  entire  organ. 
Ordinarily  there  is  little  or  no  swelling  of  the  prostate; 
and  the  bladder,  seminal  vesicles  and  rectum  are  rarely 
involved,  as  is  common  in  the  other  varieties  of  prostatic 
diseases.  In  some  aggravated  cases,  however,  the  inflam- 
mation extends  to  the  vesicles,  ampulla,  vas  deferens, 
epididymis  or  the  globus  major  and  minor.  When  the 
latter  are  affected  small  worm-like  lumps  can  be  felt  at 
each  end  of  the  testicle,  which  are  usually  tender  to  the 
touch. 

Congestion  of  the  pampiniform  and  hemorrhoidal 
plexuses  of  veins  almost  invariably  result:  the  former 
causing  varicocele,  especially  upon  the  left  side,  while  the 
latter  gives  rise  to  a  swollen  condition  of  the  rectal  mucous 

24 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  25 


Fig.   VI. 


26  PROSTATE  GLAND  AND  ADNBXA. 

membrane  resulting  in  protrusion,  ulceration  or  the  for- 
mation of  pile  tumors.  These  conditions  are  sequels  to 
prostatic  inflammation  and  not  idiopathic  diseases;  and 
the  cause  producing  them  should  be  remedied  before  treat- 
ing the  symptoms,  or  all  phases  of  the  disease  should  be 
treated  at  the  same  time. 

ETIOLOGY. 

The  most  frequent  cause  of  this  form  of  disease  of  the 
gland  is  chronic  gonorrhea,  but  it  is  not,  as  many  physi- 
cians believe,  the  only  one.  On  a  liberal  estimate,  about 
seventy-five  per  cent  of  these  cases  are  traceable  to  gonor- 
rhea as  the  source  of  the  trouble,  while  twenty-five  per 
cent  are  due  to  other  causes.  Moreover,  it  is  not  a  fact 
that  the  gland  becomes  affected  only  by  mal-treatment  of 
gonorrhea,  as  is  usually  the  opinion  of  the  patient,  who  is 
often  encouraged  in  this  view  by  rival  physicians,  as  he 
"goes  the  rounds."  It  generally  follows  treatment  even 
by  the  most  skilled  physicians,  and,  too,  in  cases  where  the 
patient  exercises  the  greatest  care. 

Prior  to  the  discovery  of  the  specific  germ,  by  Neisser, 
in  1879,  for  gonorrhea,  which  he  christened  "gonocoecus," 
the  medical  profession  were  very  much  puzzled  as  to  the 
cause,  tenacity  and  complications  of  this  disease.  Such 
early  authors  as  Selle  (1781),  Hunter  (1786),  Fournier 
(1806),  Ricord  (1836),  Foucart  (1846)  and  Brandes 
(1854)  claimed  that  there  was  a  direct  relation  between 
gonorrheal  urethritis  and  rheumatism  that  occurred  in 
conjunction  therewith. 

Guyon  (1836)  and  Thiry  (1856)  advanced  the  theory 
that  gonorrhea  developed  a  latent  rheumatic  diathesis. 
Guerin  (1846)  and  Laseque  (1876)  held  that  gonorrhea 
was  a  disease,  sui  generis,  with  a  long  period  of  incubation. 
Lewin  (1878)  advanced  the  theory  that  gonorrheal  rheu- 
matism was  due  to  reflex  irritation  from  urethritis. 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  27 

Bernultz  and  Noeggerrath^  long  before  the  discovery  of 
the  specific  coccus,  held  that  chronic  gonorrhea   in  men 
was  accountable  for  many  of  the  ailments  in  women,  who 
never  had  a  true  gonorrhea  and  whose  troubles  could  not 
be  traced  to  any  other  source. 

Like  most  great  discoveries,  that  of  IsTeisser  was  no 
exception  to  the  general  rule,  and  was  met  with  strenuous 
opposition,  until  confirmed  by  the  investigations  of  Bumm, 
Baumgarten,  Finger,  and  many  others  in  rapid  succession. 

I  shall  not  discuss  here  the  various  means  of  scientific 
research  leading  to  the  final  establishment  of  the  fact, 
which  is  now  recognized  as  a  proven  postulate,  that  the 
gonococcus  is  a  facultative  micrococcus  (schizomycete), 
found  free  in  the  purulent  discharge  of  gonorrhea  and 
within  the  substance  of  the  pus  cells.  The  latter  feature, 
together  with  the  fact  that  it  does  not  stain  with  iodine, 
are  two  of  its  most  characteristic  diagnostic  points. 
Various  diplococci  are  often  present,  so  closely  simulating 
gonococci  that  the  different  methods,  as  staining,  culture 
gi'owths,  etc.,  have  all  to  be  used  before  a  definite  differ- 
ential diagnosis  can  be  established. 

The  gonococci,  in  common  with  most  of  the  other 
micrococci,  are  anerobie  and  thrive  only  in  a  neutral  or 
alkaline  medium,  and  at  a  temperature  of  from  30°  to 
40°  C.  They  feebly  resist  an  acid  medium,  and  in  such 
have  an  ephemeral  existence.  Paradoxical  as  it  may  seem, 
from  the  tenacious  manner  with  which  this  microbe  clings 
to  its  victim,  it  is  a  delicate  germ  and  readily  succumbs 
to  the  effect  of  many  germicidal  agents,  when  brought  in 
direct  contact  with  them ;  but  the  gonococcus  is  so  minute 
that  it  conceals  itself  within  the  pus  cells,  subepithelial 
cells,  the  lacuna  of  Morgagni,  Littres  glands,  the  prostate 
and  vesicles,  and  is  out  of  reach  of  germicidal  remedies 
as  ordinarily  used. 


3b  PROSTATE  GLAND  AND  ADNEXA. 

Up  to  the  time  of  the  discovery  of  the  gonococcus  the 
remedies  in  use  were  directed^  mainly  in  an  empirical 
manner,  tovrards  controlling  the  purulent  discharge,  it 
being  unknown  at  that  time  that  the  ptis  cells  carted 
away  millions  of  the  gonococci,  which  were  the  true  source 
of  the  disease. 

Keersmaecker  and  Terhoogen  (followers  of  01>erlander) 
say,  "the  gonococcus  is  extremely  sensitive  to  desiccation.'" 
>:.  *  *  .-.j^  ^^  hidden  in  the  depths  of  the  tissues  and  is 
protected  against  destructive  agents." 

The  gonococci  are  first  implanted,  fostered  and  propa- 
gated at  or  near  the  meatus,  in  a  medium  and  locality 
most  favorable  for  their  development.  They  multiply  very 
rapidly,  work  their  way  along  the  urethra,  and,  in  spite 
of  all  measures  to  prevent  it,  to  the  prostatic  part;  thence 
directly  into  the  ejaculatory  and  prostatic  ducts  and  fol- 
licles. The  orifices  of  these  ducts  being  open  gateways, 
though  their  walls  are  in  apposition,  offer  no  resistance 
to  the  passage  of  the  germs  into  the  channels  of  the 
prostate  and  ejaculatory  ducts,  where  they  become  hidden 
within  the  follicles  of  the  gland,  and  are  thereby  pro- 
tected from  destructive  agents  as  applied  through  the 
urethra  by  the  usual  methods.  The  course  is  also  an  open 
one  to  the  seminal  vesicles  and  vas  deferens,  to  which 
they  occasionally  gain  access. 

The  cylindrical  epithelium  of  the  urethral  mucous  mem- 
brane is  the  normal  abode  of  the  gonococci.  Here  they  re- 
main active  and  aggressive,  but  after  leaving  this  their 
indigenous  soil  for  that  of  the  prostatic  and  ejaculatory 
ducts,  they  become  lethargic  and  do  not  wander  xery  far 
upon  alien  ground.  Hence  they  usually  do  not  pass  further 
than  the  interior  of  the  prostate. 

The  authoritative  estimate  of  the  proportion  of  all 
gonorrheal  cases  where  the  germs  invade  the  prostatic  ducts 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  29 

and  follicles,  is  placed  at  from  seventy-five  to  eighty-five 
per  cent;  those  that  invade  the  vesicles,  at  from  twenty 
to  thirty  per  cent;  and  the  vas  deferens  from  ten  to  fif- 
teen per  cent.  This  is  about  the  proportion  as  demon- 
strated by  the  author's  clinical  experience,  though  the  late 
fad  of  stripping  the  vesicles  would  place  gonorrheal  in- 
vasion of  the  vesicles  at  a  much  higher  ratio. 

Since  it  is  a  positive  fact,  as  proven  by  various  pathol- 
ogists in  their  examinations  of  prostatic  expressions,  that 
the  prostate  is  the  chief  abode  of  the  latent  gonococci; 
authorities  differ  upon  the  subject  as  to  whether  the  germs 
themselves  subsequently  penetrate  cellular  tissue  and  the 
walls  of  blood  and  lymph  vessels ;  or  that  they  remain  dor- 
mant within  the  prostate  secreting  toxins,  which  latter  are 
absorbed  by  these  vessels  and  carried  to  remote  parts  of 
the  body  effecting  metastasis,  as  manifested  by  rheuma- 
tism, arthritis  or  neuralgic  pains  in  various  parts  of  the 
body.  Lindeman,  Young  and  others  claim  that  the  affected 
nerves  and  joints  are  the  result  of  the  gonococci  carried  to 
these  parts  by  the  blood  currents  from  a  lesion  localized  in 
the  genito-urinary  tract.  Bumm,  Baumgarten,  Neisser, 
Bochart,  Gerbardt  and  Hartley  maintain  that  metastatic 
diseases  of  the  joints  and  nerves  are  the  result  of  mixed 
gonorrheal  infection.  Guyon,  Janet,  Furbringer  hold 
that  these  diseases  follow  as  a  direct  result  of  ptomaine 
poisoning  from  the  invasion  of  the  gonococci  in  the  tis- 
sues. There  are  others  who  advocate  similar  views  all  tend- 
ing to  the  same  result. 

The  author  concludes,  after  summing  up  the  opinions 
as  expressed  by  the  numerous  investigators  along  this  line, 
and  recounting  his  own  investigations  and  clinical  expe- 
rience, that  metastasis  is  the  result,  in  the  majority  of 
instances,  of  the  toxins  of  latent  gonococci  that  originate 
within  the  prostate  as  result  of  the  secretion  of  the  germs ; 


30  PROSTATE  GLAND  AND  ADNBXA. 

and  it  is  only  in  those  cases  where  an  abrasion  of  tissue 
in  the  genito-urinary  tract  ensues  that  the  cocci  themselves 
enter  the  circulation  and  are  carried  by  the  blood  currents 
to  remote  parts  of  the  body.  When  the  latter  occurs  and 
the  cocci  are  deposited  within  the  joints,  nerves,  etc.,  they 
readily  die,  as  it  is  a  proven  postulate  that  they  cannot 
live  outside  of  mucous  surface;  and  the  disintegration  of 
their  cadavers  intensifies  local  metastasis. 

Taking  either  view,  however,  the  question  of  vital  im- 
portance is  ]3ractically  the  same;  which  is,  that  the  germs 
are  concealed  within  the  prostate,  vesicles,  or  urethra,  and 
if  the  gonococci  can  be  destroyed  in  these  organs,  it  stops 
the  generation  of  toxins  or  destroys  the  germs  themselves, 
as  the  case  may  be,  and  subverts  their  entering  the  sys- 
tem. 

Clinical  experience  has  convinced  me  that  both  of  these 
views  are  correct.  However,  the  metastatic  diseases  are 
much  more  often  the  result  of  the  toxins  eliminated  in  the 
prostate,  than  due  to  the  presence  of  the  gonococci  them- 
selves in  the  tissues.  The  latter  condition  rarely,  if  ever, 
exists  unless  there  is  some  marked  abrasion  in  the  mucous 
lining  of  the  urethra,  prostate,  or  vesicles. 

Many  observers  have  reported  the  discovery  of  diplococci 
resembling  closely  gonococci,  and,  too,  that  would  decolor- 
ize by  Gram's  Method,  and  where  cultures  would  produce 
a  urethritis  of  three  or  four  days'  duration  but  not  a  true 
gonorrhea.  The  writer  has  noted  many  similar  cases,  from 
clinical  observation,  and  has  been  thoroughly  convinced 
that  these  germs  are  non-virulent  gonococci,  rendered 
sterile  by  their  having  remained  dormant  for  so  many 
years  within  the  prostate  or  vesicles. 

During  an  acute  exacerbation  of  prostatitis,  causing  ex- 
cessive discharge  within  the  urethra,  these  latent  cocci  are 
swept  along  with  the  discharge  "knd  at  times  set  up  a  ure- 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  31 

thritis  of  short  duration,  but  they  lack  sufficient  vitality  to 
create  a  true  gonorrhea.  But,  should  the  cocci  enter  the 
blood  current,  phagocytosis  would  be  the  most  probable  re- 
sult ;  or,  coupled  with  the  lethal  effect  of  blood  serum  upon 
the  germs,  they  could  scarcely  escape  destruction.  More- 
over, it  is  an  indisputable  fact  that  gonococci  cannot  live 
except  within  a  mucous  membrane,  and,  should  it  be  pos- 
sible for  them  to  escape  the  destructive  agents  before  men- 
tioned, in  their  transit  along  the  blood  currents,  it  would 
seem  impossible  that  they  could  live  sufficiently  long,  out- 
side of  a  mucous  surface,  to  effect  metastatic  pathogenesis, 
except  by  poisons  resulting  from  their  death  and  decay. 

I  dwell  upon  this  point  at  some  length  because  the  ques- 
tion is  an  important  one  and  one  that  is  presented  almost 
daily  in  active  practice,  in  regard  to  obscure  chronic  dis- 
eases. 

Should  these  germs  be  carried  to  various  parts  of  the 
body,  and,  if  it  were  possible  for  them  to  live  indefinitely 
as  they  do  within  the  mucosa  of  the  prostate,  but  few  who 
have  had  gonorrhea  could  withstand  their  ravages.  Be- 
sides, it  would  be  impossible  to  reach  them,  if  scattered  over 
the  entire  body,  with  destructive  agents  that  would  not 
prove  fatal  to  the  patient. 

The  columnar  epithelium  of  the  mucosa  within  the 
prostate  being  in  closer  anatomical  relation  to  that  of  the 
urethra,  serves  to  perpetuate  the  lives  of  these  germs  better 
and  longer  than  other  mucous  surfaces,  though  they  do  not 
propagate  therein.  The  mild  alkaline  reaction  of  the  pros- 
tatic secretion  also  ministers  to  the  maintenance  of  their 
lives. 

Clinical  results  following  the  treatment  of  the  prostate, 
together  with  frequent  examinations  of  the  prostatic  ex- 
pressions, have  convinced  me  that  the  prostate  is  the  chief 
abode  of  the  latent  gonococci.    I  have  traced,  in  numerous 


32  PROSTATE  GLAND  AND  ADNEXA. 

instances,  the  origin  of  remote  arthritic  and  neuralgic 
pains  indirectly  to  the  prostate,  by  destroying  the  hidden 
germs  within  the  gland,  which  were  evidently  the  fons  et 
origo  malorum,  and  which  was  evidenced  by  the  imme- 
diate disappearance  of  all  symptoms.  The  destruction  of 
the  gonococci  within  the  prostate  having  suppressed  the 
generation  of  the  toxins,  and  the  poisons  being  no  longer 
carried  through  the  lymph  and  blood  channels  to  the  tis- 
sues, all  pain  would  disappear  and  recovery  would  be  rapid. 
On  the  contrary,  were  it  probable  that  the  gonococci  had 
lodged  and  remained  alive,  within  the  Joints  and  other  tis- 
sues, instead  of  their  toxins,  local  treatment  of  the  prostate 
would  not  relieve  the  condition,  and  it  would  be  impossible 
to  do  so  where  polyarthritis  existed. 

Serous  and  synovial  membranes  and  nerves  are  espe- 
cially marked  for  the  morbific  effects  of  the  toxins  of 
gonococci.  The  pathological  changes  that  occur  as  denoue- 
ment of  the  toxins,  in  the  joints  and  serous  cavities  pro- 
duce conditions  favorable  for  the  development  of  diplococci 
or  streptococci,  that  closely  simulate  gonococci;  which 
have  given  credence  to  the  extensive  migration  of  the  lat- 
ter. 

Owing  to  the  tenacious  sequels  of  gonorrheal  infection, 
and  the  metastasis  resulting  therefrom,  it  is  the  opinion 
of  many  physicians  that,  when  one  once  has  gonorrhea, 
it  is  never  entirely  eradicated ;  and  that  it  is  attended  with 
greater  fatality  than  syphilis.  The  latter  view  is  generally 
conceded,  taking  the  sequels  of  gonorrhea  into  considera- 
tion. 

Prostatic  expressions  have  shown  gonococci  to  be  pres- 
ent in  the  fluid,  thus  forced  out,  for  many  years  after 
complete  subsidence  of  all  gonorrheal  symptoms.  Some 
writers  have  discovered  latent  gonococci  in  the  gland  as 
long  as  sixteen  years  after  having  had  an  attack. 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  33 

The  past  decade  has  been  prolific  of  much  research 
as  to  the  habits,  life  and  pathogenesis  of  these  germs,  which 
has  been  the  means  of  revealing  obscure  diagnosis  in  many 
instances;  and  especially  since  the  discovery  of  their  hid- 
ing place  in  the  prostate. 

Furthermore,  these  germs  may  remain  dormant  secret- 
ing toxins  that  penetrate  and  maintain  an  inflamed  pros 
tate,  but  not  effect  metastasis  for  a  long  period,  yet  cause 
reflex  neurotic  disturbances. 

When  the  gonococci  have  entered  the  prostate,  they 
begin  the  secretion  of  toxins,  which  at  first  cause  suba- 
cute, then  chronic  inflammation  of  the  follicles  and  ducts, 
and  subsequently  parenchymatous  affection  of  the  entire 
gland;  the  result  of  which  maintains  a  constant  muco- 
purulent discharge  tliat  is  poured  out  upon  the  floor  of 
the  prostatic  urethra.  This  secretion  must  necessarily 
pass  along  the  canal  toward  the  meatus.  The  discharge 
may  be  so  slight  as  to  appear  only  as  the  "morning  drop," 
or  it  may  become  desiccated  by  the  warmth  of  the  urethra, 
and  noted  only  by  gluing  together  of  the  lips  of  the  meatus 
?n  the  morning;  or  it  may  even  escape  observation  alto- 
gether. Then  again,  the  discharge  may  become  quite  pro- 
fuse at  times  as  influenced  by  excitation,  as  by  dissipation 
or  other  causes,  and  continue,  regardless  of  all  injections, 
sounds  or  other  caustic  applications  to  the  deep  urethra, 
or  constitutional  medication;  as  such  treatments  do  not 
penetrate  the  ducts  to  reach  the  seat  of  the  trouble. 

The  gonococci  may  remain  hidden  within  these  deep  tis- 
sues for  years  in  a  latent  state,  unless,  by  certain  irrita- 
tive conditions,  as  induced  by  "haclio  et  venere"  when  a 
conious  prostatic  discharge  is  excited,  and  the  germs  are 
cff"^ried  by  the  excessive  secretion  into  the  urethra,  where 
they  may  become  auto-inoculable,  and  set  up  a  fresh  al- 
though mild  attack  of  gonorrhea,  or  a  plain  urethritis. 


34  PROSTATE  GLAND  AND  ADNEXA. 

It  has  also  been  demonstrated  by  Oberlander,  Verhoo- 
gen.  Finger  and  others  that  these  germs  may  remain  dor- 
mant for  three  or  six  years,  or  even  longer,  when,  under 
certain  conditions,  they  may  become  aroused  to  activity 
and  manifest  their  pathogenesis ;  though  not  in  as  virulent 
form  as  the  prime  attack.  Numerous  instances  have  come 
under  the  author's  observation  where,  even  among  married 
men,  unmistakable  evidence  of  latent  gonococci  had  been 
aroused  to  activity,  developing  an  acute  urethritis  which 
could  not  be  traced  to  another  origin  than  that  of  auto- 
inoculation. 

OTHER   CAUSES. 

During  erotic  excitement,  whether  normally  or  abnorm- 
ally, the  prostate  becomes  hyperemic,  either  synchronously 
with  or  independent  of  penile  erection.  If  this  excite- 
ment is  unduly  prolonged,  by  toying  with  women,  indulg- 
ing continuously  in  libidinous  thoughts,  association  with 
prostitutes,  masturbation,  continence  or  excessive  inter- 
course, it  causes  venous  stasis  or  congestion  of  the  gland, 
resulting  ultimately  in  subacute  or  chronic  prostatitis; 
which  readily  extends  and  involves  the  prostatic  urethra 
and  adjacent  parts.  This  condition  provokes  a  prostatic 
discharge  similar  to  that  of  gleet  and  is  often  mistaken 
for  such.  This  discharge  being  poured  out  within  the 
urethra,  induces  prostatic  urethritis  in  the  same  way  as 
that  of  the  toxins  of  gonorrhea,  and  which  may  extend 
the  entire  length  of  the  urethral  canal,  rendering  it  tender 
and  supersensitive.  Many  times  have  I  known  such  con- 
ditions treated  many  years  for  gonorrhea,  when  there  were 
no  indications  of  the  latter. 

It  is  somewhat  difficult  to  define  just  what  consti- 
tutes excessive  sexual  indulgences,  as  individuals  vary  so 
much  in  their  physical  organism  and  sexual  propensities. 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  35 

That  which  would  be  excessive  and  injurious  to  one  man, 
might  not  be  to  another. 

Masturbation. — In  addition  to  its  local  baneful  effect 
upon  the  urethra  and  gland  masturbation  is  attended  with 
an  excessive  drain  upon  the  nervous  system,  and  is,  con- 
sequently, more  apt  to  provoke  some  form  of  mental  dis- 
turbance, owing  to  the  absence  of  the  natural  psychical 
stimulus  of  the  opposite  sex,  than  by  the  normal  act. 

The  evil  effect  of  masturbation  upon  the  prostate  and 
vesicles  primarily,  and  the  nervous  system  secondarily, 
has  been  over-estimated  by  many,  and  treated  with  too 
much  indifference  by  others.  The  fact  of  the  almost  uni- 
versal practice,  at  some  time  of  life,  among  males,  renders 
it  a  convenient  source  to  which  to  attribute  all  the  sexual 
and  nervous  diseases,  not  traceable  to  that  of  gonorrheal 
origin. 

Charlatans  reap  a  rich  harvest  among  youths  and,  too, 
older  men,  who,  being  over-sensitive,  are  too  prudish  or 
secretive  to  consult  their  family  physician  and  fall  an  easy 
victim  to  their  tenets  and  ruse.  The  family  physician, 
too,  is  often  accountable  for  this,  by  not  making  a  thor- 
ough examination  of  the  case  when  consulted,  treating  the 
matter  with  too  much  indifference,  dismissing  him  with  a 
tonic,  or  telling  him  it  is  "all  in  his  head."  The  fact  is 
that  most  of  those  addicted  to  the  habit  are  so  ashamed  of 
it,  that  they  will  deceive  the  physician,  in  the  large  ma- 
jority of  instances,  by  denying  the  practice  altogether,  or 
minimize  the  extent  of  indulgence  so  as  to  mislead  him. 

Objective  symptoms  alone,  as  revealed  by  an  examina- 
tion, can  determine  the  extent  of  the  lesion  as  induced  by 
the  vice.  I  place  but  little  credence  in  what  one  says  about 
the  frequency  or  length  of  time  he  Tiad  indulged  (as  they 
all  say  they  have  quit  now). 

Phimosis  or  an  elongated  prepuce  often  serves  as  an 


36  PROSTATE  GLAND  AND  ADNEXA. 

exciting  cause,  both  towards  precipitating  and  perpetuat- 
ing the  habit.  The  late  Dr.  S.  W.  Gross  attributed  the  be- 
ginning and  continuance  of  masturbation  as  due  largely  to 
the  redundant  foreskin. 

The  deleterious  effects  resulting  from  masturbation  are 
not  due  to  the  loss  of  semen,  but  to  the  nervous  shocks 
and  the  local  irritation  to  the  sensitive  urethra,  prostate 
and  vesicles,  causing  a  congestion  of  these  latter  two  or- 
gans; and  a  subsequent  disturbance  of  the  cerebro-spinal 
nervous  sj^stem.  While  excessive  sexual  indulgence  is  de- 
pressing to  the  nervous  and  ph5^sical  organism,  and  causes 
congestion  and  inflammation  of  the  sexual  organs,  yet  it 
is  devoid  of  the  nervous  shock  that  attends  the  unnatural 
manner,  as  well  as  the  local  irritation  resulting  therefrom. 
The  latter  jDrovokes  more  frequent  repetitions  of  the  act. 

Opportunity,  too,  also  favors  frequent  indulgence,  and 
the  sexual  organ  that  suffers  most  is  unquestionably  the 
prostate  gland. 

Cold  weather  or  wet  feet  aggravate  all  conditions  of 
the  prostate  and  bladder,  and  it  is  often  the  case  that  one 
affected  with  chronic  prostatitis  is  comparatively  comfort- 
able through  the  summer,  but  begins  to  suffer  on  the  ap- 
proach of  cold  weather.  Then  again  one  may  have  been 
conscious  of  the  .existence  of  some  form  of  bladder  trouble 
for  3'ears,  but  of  not  sufficient  gravity  to  consult  a  phy- 
sician, until  having  gotten  his  feet  wet,  or  exposed  to  se- 
vere cold  weather,  when  an  acute  attack  is  precipitated. 

All  forms  of  prostatic  diseases  are  subject  to  acute  ex- 
acerbations and  violent  instrumentation;  strong  injections 
within  the  deep  urethra,  large  doses  of  turpentine  or  can- 
tharides  often  provoke  an  inflamed  condition  of  the  gland. 

Horseback  and  bicycle  riding  are  etiological  factors  of 
no  small  importance,  and  especially  when  the  gland  is  al- 
ready tender  or  when  there  are  other  excitant  causes.  The 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  37 

pressure  of  the  saddle  upon  the  perineum,  and  the  jolting 
of  a  misstep  of  the  horse,  or  by  a  rough  road  for  the 
bicycle,  is  exerted  upon  the  deep  urethra  or  prostate. 
Many  men,  suffering  from  prostatitis,  have  told  me  that 
they  had  observed  the  ill  effects  of  a  ride  upon  their  wheels. 

Continence. — A  knotty  problem,  that'  often  arises  in 
the  treatment  of  diseases  of  the  prostate,  relates  to  the 
effect,  that  totally  refraining  from  sexual  congress,  has 
upon  the  gland  of  robust  persons  not  in  position  to  nat- 
urally indulge  their  sexual  propensities.  As  before  stated 
it  is  a  fact,  recognized  by  all  leading  genito-urinary  spe- 
cialists, that  the  prostate  in  all  healthy  men  normally  be- 
comes hyperemic  during  erotic  excitement;  and  it  is  in 
accordance  with  natural  laws,  that  such  excitement  occurs 
at  certain  intervals,  regardless  of  whatever  moral  or 
persuasive  influence  may  be  exerted  to  the  contrary.  While 
this  state  may  be  greatly  mollified  by  one's  habits,  and  by 
surrounding  influences  to  divert  the  mind  in  channels  of 
chaste  morality;  yet  the  intrinsic  excitation,  as  exerted  by 
the  sexual  organs,  in  performing  their  normal  functions, 
is  transmitted  to  the  sexual  brain  or  nerve  center,  which, 
in  turn,  excites  hyperemia,  especially  in  the  prostate  gland 
and  penis.  This  local  congestion  or  nervous  excitation  can 
be  controlled  for  a  time  without  injury  either  to  the  gland 
or  nervous  system;  but  by  continual  recurrences  of  sexual 
erethism,  engendering  the  accumulation  of  semen,  over- 
distending  the  vesicles  to  the  extent  of  causing  discom- 
fort, and  producing  continuous  prolonged  prostatic 
hyperemia,  finally  results  in  congestion,  irritation  and  in- 
flammation ;  and,  by  reason  of  the  highly  sensitive  nervous 
organization  of  the  gland,  and  the  reciprocal  relation  it 
bears  to  the  sympathetic  and  cerebro-spinal  nerve  centers, 
various  nervous  disturbances  of  the  latter  are  produced. 

I  have  had  under  mv  observation  several  cases  of  chronic 


38  PROSTATE  GLAND  AND  ADNBXA. 

priapism  and  different  forms  of  neurotic  aberrations,  evi- 
dently due  to  continence  as  the  prime  cause,  and  resulting 
eventually  in  chronic  prostatitis,  and  all  the  attending 
sequels  incident  to  the  disturbance  of  the  sexual  organs, 
and  nervous  disorders. 

There  are  others  where  the  surrounding  influences, 
united  with  lascivious  readings,  libidinous  thoughts  and 
the  intrinsic  excitations  of  the  normal  functions  of  the  or- 
gans, produce  chronic  sexual  and  nervous  disturbances  at 
a  much  earlier  date  and  in  a  more  aggravated  form.  For 
this  reason  I  have  usually  much  less  trouble  in  treating 
married  men  than  single. 

Age,  vocation  and  physical  condition  must  also  be 
taken  into  consideration.  It  is  not  difficult  for  a  man  past 
thirty,  of  delicate  physique  and  whose  business  involves 
mental  exertion  totally  at  variance  with  any  lascivious  im- 
pressions, to  abstain  from  sexual  relations  for  an  indefinite 
period  without  injury  resulting  from  violating  natural 
laws.  But  in  the  case  of  a  young  man  of  robust  health, 
whose  occupation  requires  but  little  mental  exertion,  and 
whose  surroundings  and  associates  tend  to  excite  lust,  con- 
tinence would  cause  much  prostatic  irritation,  congestion 
and  inflammation. 

Alcoholic  stimulants  of  all  kinds  tend  to  produce 
erethism  and  congestion  of  the  gland  and  should  be  avoided. 
Beer  and  wines  have  particularly  a  baneful  influence. 

SYMPTOMS. 

In  most  cases  the  symptoms  are  common  in  many  re- 
spects to  those  of  stricture  of  large  calibre,  localized 
urethritis,  vesiculitis,  or  chronic  gonorrhea;  or  all  these 
may  coexist.  In  many  instances  these  are  apparently  free 
from  any  disease  of  the  sexual  organs,  and  are  manifested 
by  mental  depression,  lack  of  confidence,  melancholia,  im- 


SUBACUTE  OR  CHRONIC   PROSTATITIS.  39 

potency,  nervous  dyspepsia,  impaired  memory  or  insomnia. 

The  eyes  are  usually  dull,  and  often  become  so  disturbed 
as  to  necessitate  consulting  an  oculist. 

Dysuria  is  rare  unless  complicated  with  stricture,  gran- 
ular urethritis  or  vesiculitis.  In  fact  the  urine  being 
normally  an  aseptic  fluid  resists  the  development  of 
pathogenic  bacteria,  although  as  many  as  thirty  varieties 
of  non-pathogenic  bacteria  are  often  present  therein. 

GLEET. 

A  slight  continuous  discharge  is  a  prominent  symptom 
of  prostatitis.  It  unquestionably  signifies  the  presence  of  a 
pathological  lesion  in  some  part  of  the  genito-urinary 
tract. 

The  origin  £ind  source  of  this  discharge  has  been  the 
subject  of  much  comment  and  investigation,  as  well  as 
diversity  of  opinion  among  genito-urinary  specialists.  The 
fact  that  such  a  discharge  does  arise  from  some  ulcerated, 
granular  or  inflamed  surface  is  indisputable;  and  the 
urethra,  being  the  most  favorable  site  for  such,  has  suffered 
the  burden  of  caustic  applications  and  operative  procedure. 

The  writings  of  Dr.  Otis,  some  years  ago,  attributing 
this  discharge  to  infiltration,  coarctation  or  stricture  of 
large  calibre,  was  followed  by  rash  and  indiscriminate  cut- 
ting of  the  urethra  for  almost  every  conceivable  trouble  of 
the  genito-urinary  organs.  Dr.  Fuller  states  in  his  book 
on  "Disorders  of  the  Male  Sexual  Organs,"  that  "as  a  re- 
sult of  Dr.  Otis'  writings  on  strictures  of  large  calibre,  he 
had  seen  cases  that  had  been  cut  for  pus  in  the  urine,  which 
were  of  pelvic  origin.  He  also  reports  a  case  having  come 
under  his  care  that  had  been  cut  seventeen  times  for  stric- 
ture, when  the  cause  of  the  suffering  was  vesiculitis. 

The  author  has  seen  quite  a  number  of  cases  that  had 
been  operated  upon  two  or  three  times  for  stricture,  where 


40  PROSTATE  GLAND  AND  ADNEXA. 

there  were  no  indications  of  such,  but  whose  symptoms 
were  due  to  prostatitis  or  vesiculitis,  causing  a  constant 
gleety  discharge. 

While  the  author  thinks  the  criticisms  of  Dr.  Otis' 
teachings  are,  at  least,  in  part  justifiable,  yet  any  one  hav- 
ing read  Dr.  Fuller's  book,  before  mentioned,  would  infer 
that  urethral  discharges,  as  well  as  sexual  disorders,  were 
traceable  almost  exclusively  to  vesiculitis.  While  the  title 
of  his  book  is  "Disorders  of  the  Male  Sexual  Organs," 
yet  I  shall  state  that,  with  a  conservative  estimate,  at  least 
five-sixths  of  its  contents  is  devoted  to  vesiculitis  and  a 
stripping  of  the  vesicles.  To  state  that  the  latter  has  be- 
come one  of  the  fads  of  today  is  placing  it  mildly;  and  I 
shall  venture  the  assertion  that  it  will  soon  drop  into  as 
utter  disfavor  as  that  of  the  Dr.  White's  castration  en- 
thusiasm as  advocated  a  few  years  ago. 

There  are  others  who  are  ready  to  accredit  most  of  these 
symptoms  to  chronic  urethritis.  The  book  of  Keersmaecker 
and  Verhoogen,  on  chronic  urethritis,  is  an  excellent 
treatise  upon  the  subject,  and  especially  from  a  diagnostic 
point  of  view,  evidencing  extensive  research,  yet  it  appears 
that  too  much  stress  is  placed  upon  local  lesions  of  the 
urethra  alone. 

Gleet  is  not  a  disease  per  se,  but  a  symptom  of  an  exist- 
ing lesion,  and  while  it  is  generally  understood  to  be  a 
sequel  of  gonorrhea,  yet  scant  discharges  from  the  urethra 
occur  from  other  causes  so  closely  simulating  it,  that  it 
is  difficult  to  draw  a  marked  line  of  distinction. 

The  writer  considers  that  when  a  persistent  urethral 
discharge,  mild  in  character,  resists  all  urethral  treatment 
it  is  symptomatic  of  prostatitis  in  some  form.  Vesiculitis 
may  coexist,  and  the  vesicles  should  be  examined,  but,  as 
the  large  majority  of  cases  of  vesiculitis  originate  from  the 
urethra,  or  prostate,  whether  due  to  gonorrhea,  masturba- 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  41 

tion  or  other  causes,  the  infection  or  extension  of  the 
inflammation  must  necessarily  pass  through  the  prostate 
before  reaching  the  vesicles,  and  hence  must  involve  the 
former.  It  is  therefore  irrefutable  that  the  prostate,  being 
in  closer  proximity  to  the  urethra,  and  owing  to  its  ex- 
posed position  to  the  bladder,  is  much  more  liable  to  be- 
come involved  than  the  vesicles;  yet  the  trouble,  if  of 
aggravated  form,  often  extends  and  affects  the  latter. 

The  urethra  is  still  more  exposed  than  even  the  prostate, 
and  never  escapes  disturbance  when  disease  of  the  latter 
has  existed  any  great  length  of  time;  as  the  irritative  dis- 
charge from  the  prostate  or  vesicles  passing  out  into  the 
urethra — their  only  source  of  exit — would  eventually  pro- 
voke urethritis;  and  upon  examination,  one  finding  a 
sensitive  or  inflamed  canal,  infers  that  the  trouble  was 
confined  to  the  latter  instead  of  the  prostate.  In  fact, 
urethritis  is  often  the  most  prominent  subjective  or  ob- 
jective symptom.  It  is  evident,  therefore,  that  by  treating 
and  relieving  the  urethra  for  the  time  only,  the  symptoms 
would  recur,  and  continue  to  do  so  until  the  prostatitis  or 
vesiculitis  was  cured.  The  patient  continues  to  return  and 
report  the  same  "morning  drop,"  or  forked  stream,  as 
indicating  the  gluing  together  of  the  lips  of  the  meatus, 
as  result  of  the  drying  of  the  discharge  before  escaping. 
This  continues  until  the  patience  of  both  the  patient  and 
doctor  becomes  exhausted,  and,  to  the  great  relief  of  the 
latter,  the  former  goes  to  another  physician,  through  the 
advice  of  a  friend,  with  the  same  result — all  dosing  the 
urethra  and  stomach,  as  it  is  evident,  that,  by  simply  treat- 
ing the  urethra,  the  trouble  could  never  be  relieved.  Again, 
should  the  disturbance  have  originated  in  the  urethra  and 
extended  to  the  prostate  or  vesicles,  the  same  or  similar 
symptoms  would  appear;  which  would  necessitate  the 
treatment  of  all  three  organs  as  before.    Urethritis  would 


42  PROSTATE  GLAND  AND  ADNBXA. 

be  aggravated  and  perpetuated  by  the  prostatic  discharge. 

This  chronic  discharge  has  been  the  hete  noire  of  the 
profession  from  time  immemorial,  since  they  have  mostly 
confined  their  treatment  to  the  urethra,  or  even  should 
they  realize  its  source,  their  means  of  reaching  it  have 
been  inadequate. 

The  urethra  has  withstood  sounds,  injections,  cauteries 
and  lavages  for  more  than  a  century,  and  in  many  instances 
with  some  relief,  but  never  cured. 

The  objective  symptoms  reveal  a  red  and  often  con- 
tracted meatus;  as  before  stated  the  lips  of  which  are 
frequently  glued  together,  by  the  des  iccated  gleety  dis- 
charge. Upon  passing  a  bougie  a  boule  the  first  tender 
point  encountered  is  usually  about  six  inches  down  the 
urethra,  at  the  juncture  of  the  pendulous  with  the 
membranous  portion.  Here  there  often  exists  an  ero- 
sion, granular  surface  or  probably  a  stricture.  Should 
one  of  the  former  exist,  without  a  stricture,  the  instru- 
ment may  be  arrested  thereat,  by  the  contraction  of  the 
muscular  fibers,  or  external  sphincter,  due  to  local  irrita- 
tion, as  induced  by  the  contact  of  the  instrument  with  the 
sensitive  point.  The  membranous  part  of  the  canal  is 
quite  tender,  and  the  most  favorable  site  for  stricture,  ex- 
cepting that  part  near  the  meatus.  On  reaching  the  pros- 
tatic portion  of  the  urethra  the  instrument  detects  the 
most  sensitive  part  of  the  canal,  which  imparts  the  feel- 
ing of  roughness,  indicating  a  granular  surface  over  which 
the  instrument  passes.  Juft  as  we  regard  the  tongue  as 
an  index  to  the  condition  of  the  stomach,  so  in  like  man- 
ner do  I  consider  the  prostatic  urethra  symptomatic  of 
the  state  of  the  prostate  or  vesicles.  The  instrument,  if 
small,  may  enter  the  utricle  and  become  arrested,  or  should 
the  prostatic  urethra  be  excessively  sensitive  the  bougie 
may  not  pass  on  account  of  spasm;  either  of  these  condi- 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  43 

tions  may  be  mistaken  for  stricture,  but  it  must  be  re- 
membered that  an  organic  stricture  never  occurs  in  the 
prostatic  portion  of  the  canal. 

At  times,  when  the  urine  is  acrid,  there  is  some  diffi- 
culty in  thoroughly  evacuating  the  bladder.  The  irrita- 
tive effect  of  the  urine  upon  the  tender  part  of  the  canal 
causes  a  contraction  of  the  circular  muscular  fibers  of  the 
urethra  at  that  point,  which  subsequently  relax  and  allow 
the  passage  of  a  few  drops  or  a  drachm  of  urine  thereafter. 
Some  have  slight  pain  just  as  the  urine  starts,  others  at 
the  close  of  urination,  which  is  often  attended  with  the 
sensation  of  still  more  to  pass. 

The  urethra,  being  the  chief  channel  through  which  to 
reach  the  prostate  for  direct  treatment,  and  often  too,  its 
local  lesion  provoking  and  maintaining  prostataic  affec- 
tions in  many  instances,  must  necessarily  receive  especial 
attention  in  the  consideration  of  any  form  of  the  prostatic 
disease.  The  secretions  of  the  prostate  or  vesicles,  passing 
over  the  urethral  mucosa,  produce  certain  pathological 
changes.  These  changes  are  not  uniform  throughout  the 
canal,  but  are  generally  confined  to  localized  patches, 
where  the  epithelial  coating  loses  its  smooth,  moist  surface 
and  becomes  rough  and  hyperemic  or  granular.  The  most 
favorable  site  for  these  patches  is  the  prostatic  urethra 
(which  never  escapes  involvement),  the  bulbo-membra- 
nous  junction  and  fossa  navicularis.  In  some  cases  the 
entire  urethral  canal  is  more  or  less  affected. 

By  means  of  a  flexible  bougie  a  boule,  passed  slowly 
along  the  urethra,  the  most  inexperienced  physician  can 
readily  detect  the  rough,  tender  patches.  Every  general 
practitioner  should  therefore  supply  himself  with  three 
sizes  of  these  bulbous  bougies — Nos.  12,  14  and  16,  Am. 
The  most  accurate  way  of  detecting  the  real  character 
of  localized  lesions  within  the  urethra  and  bladder,  as  well 


44  PROSTATE  GLAND  AND  ADNEXA. 

as  the  condition  of  the  prostate  and  its  ducts,  is  by  means 
of  a  good  urethroscope  and  cystoscope. 

Much  credit  is  due  Oberlander  of  Dresden  in  achiev- 
ing modern  urethroscopy  and  cystoscopy.  By  his  untiring 
efforts  he  succeeded  in  constructing  an  instrument  through 
which  a  direct  light  could  be  transmitted  to  a  localized 
area  within  the  urethra  or  bladder.  But  the  platinum  wire 
used  by  him  would  become  quite  hot  and  it  required  a 
cooling  apparatus  that  rendered  the  instrument  large  and 
cumbersome;  besides  encroaching  upon  the  calibre  of  the 
instrument,  limiting  thereby  the  field  of  vision.  So  it  fell 
to  the  lot  of  an  American  (Dr.  Henry  Koch  of  Rochester) 
to  develop  the  mignon  lamp,  which  consumes  an  energy  of 
only  four  or  five  volts  and  0.2  of  an  ampere.  This  lamp 
is  practically  devoid  of  heat,  and  can  be  inserted  within 
the  urethra  or  bladder  for  an  indefinite  time  without  the 
least  inconvenience  to  the  patient. 

Various  improvements  have  been  made  within  the  last 
few  years  until  now  localized  sores  can  be  easily  detected 
within  the  urethra,  bladder  or  around  the  prostate,  and 
medicinal  applications  applied  directly  thereto.  Besides, 
there  is  no  guessing  at  the  morbid  condition  or  its  loca- 
tion. 

The  size  of  the  instrument  I  prefer  is  26  F.,  and,  if 
the  calibre  of  the  urethra  is  too  small  to  admit  of  its  en- 
trance, it  is  pathologically  narrowed  at  some  portion  of 
the  canal  and  should  be  relieved  before  attempting  an  ex- 
amination. 

The  instrument  should  be  carefully  examined,  ren- 
dered aseptic,  and  the  light  tested  before  it  is  introduced. 
In  some  few  cases  the  urethra  is  so  callous  to  instrumenta- 
tion that  it  is  unnecessary  to  use  an  anesthetic,  but  where 
it  is  unduly  sensitive  I  always  use  cocaine  locally,  as  it  is 
unpardonable  to  subject  one  to  pain  when  it  can  be  so 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  45 

easily  and  harmlessly  avoided.  For  this  purpose  I  use 
from  three  to  twenty  per  cent  strength  of  cocaine,  de- 
pendent upon  the  degree  of  sensitiveness  of  the  urethra. 
In  most  cases  the  prostatic  portion  of  the  canal  is  the 
most  sensitive,  and  the  greater  amount  of  the  cocaine 
should  be  applied  thereto.  By  means. of  instrument  No. 
IX.  the  medicine  can  be  applied  to  any  portion  of  the  ure- 
thra or  neck  of  the  bladder  as  desired,  and,  by  exercising 
any  degree  of  caution,  with  impunity.  The  cocaine  is 
drawn  into  the  instrument  by  means  of  the  bulb  at  the 
upper  extremity,  similar  to  that  of  a  medicine  dropper, 
and  is  pressed  out  in  the  same  manner.  If  the  upper  por- 
tion of  the  canal  is  not  tender,  or  but  slightly  so,  I  do  not 
press  the  bulb  until  the  instrument  reaches  the  prostatic 
portion,  when  slight  pressure  is  made,  but  not  sufficiently 
to  force  out  the  entire  amount  of  the  fluid.  The  bulb  is 
then  allowed  to  expand,  when  the  surplus  of  the  liquid  is 
again  taken  up.  After  waiting  a  minute  or  so  the  bulb  is 
again  pressed  as  before.  This  is  continued  several  times 
before  the  entire  amount  is  ejected.  Should  the  pendulous 
urethra  be  sensitive,  it  can  be  applied  along  its  entire 
length  in  the  same  way  as  before  described.  I  use  a  bulb 
on  my  instrument  that  only  holds  twenty  or  thirty  minims, 
so  that  a  twenty  per  cent  strength  of  cocaine  can  be  used 
with  impunity  and  the  parts  thoroughly  anesthetized, 
whereas,  by  an  ordinary  syringe,  as  is  generally  used,  it 
would  be  dangerous. 

It  has  become  a  fad  among  some  physicians  to  cathe- 
terize  the  ureters,  when  more  than  one  case  of  infection 
has  been  carried  from  the  bladder  into  these  tubes,  thence 
to  the  kidneys.  Besides,  the  cylinder  of  the  plain  cysto- 
scope  is  larger  and  gives  a  better  field  of  vision. 

I  also  use  a  proctoscope   or  sigmoidoscope,  which  is 
constructed  upon  the  same  general  principle  as  that  ol 


PROSTATE    GLAND    AND    ADNEXA. 


Fig  VII. 


Fig.  8  illustrates  the  use  of  the  cytoscope  in  viewing  the  interior 
of  the  bladder  and  locating  a  small  tumor. 


46a 


Fig.  9  gives  a  practical  illustration  of  the  cytoscope  as  used  by 
the  author  to  determine  the  exact  state  of  the  prostate  and  neck  of 
the  bladder,  without  guessing  at  their  condition. 

46b 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  47 

the  cystoscope.  This  is  a  very  useful  instrument  in  de- 
tecting the  condition  of  the  prostate,  vesicles  and  rectal 
mucosa.  Before  having  procured  this  instrument  I  was 
in  great  measure  groping  in  the  dark  with  reference  to 
the  diagnosis  as  to  the  real  condition  of  the  vesicles,  peri- 
vesiculitis  and  the  rectal  mucosa  around  the  prostate. 

I  have  found  the  best  way  to  use  the  instrument  is  to 
pass  it  gently  into  the  rectum  and  up  to  the  sigmoid  flex- 
ure; the  obturator  is  then  removed  and  the  eye-piece,  or 
metal  plug,  is  inserted,  together  with  the  air  bulb.  Gentle 
pressure  of  the  latter  distends  the  rectum  around  the  vesi- 
cles, and  also  prevents  the  fecal  matter  from  dropping 
down  within  the  tube.  Mild  distention  of  the  rectum 
with  air  discloses  the  condition  of  the  vesicles  and  sur- 
rounding tissues  perfectly.  The  tube  is  slowly  withdrawn 
and  at  the  same  time  continuing  the  air  pressure  when  the 
entire  rectum  and  prostate  can  be  accurately  noted. 

The  pressure  of  the  air  should  not  be  too  great  or  it 
will  cause  over  distention  of  the  colon  and  result  in 
colicky  pains. 

The  voltage  necessary  for  lighting  these  endoscopes 
can  be  obtained  from  cell  batteries,  provided  they  are  sup- 
plied with  suitable  rheostats.  The  objection  to  cell  bat- 
teries, however,  is  that  the  cells  deteriorate  with  use,  caus- 
ing, when  much  used,  irregular  current  or  voltage. 

I  prefer  the  current  from  the  direct  incandescent  cir- 
cuit, with  a  properly  constructed  controller,  when  the  volt- 
age is  uniform,  whether  used  five  minutes  or  all  day  long. 
Fig.  VII.  illustrates  a  battery  or  controller  that  meets 
all  indications  for  this  purpose.  In  fact,  it  is  the  best 
apparatus  upon  the  market,  as  it  controls  the  current  from 
a  fraction  of  a  volt  to  that  of  fifty  or  more.  It  is  not  only 
useful  for  lighting  these  delicate  lamps,  but  can  be  used 
for  all  electrolytic  work  and  cataphoresis,  besides  supply- 


48  PROSTATE  GLAND  AND  ADNEXA. 

ing  the  primary  and  secondary  faradic  currents  of  any 
desired  strength. 

NOCTUENAL  EMISSIONS. 

Nocturnal  emissions  are  not  infrequent,  and  especially 
when  granular  prostatic  urethritis  coexists  with  inflamma- 
tion of  the  gland.  Such  lesion  of  the  urethra  inhibits  its 
normal  elasticity,  which,  as  a  result,  can  not  be  accom- 
modated to  the  elongated  penis  when  erect,  and  produces 
an  undue  drawing  upon  that  part  of  the  tender  canal  that 
causes  a  fortuitous  seminal  discharge.  One  emission  often 
irritates  the  prostate  or  vesicles  and  thereby  causes  a  second 
or  third  in  successive  nights,  and  occasionally  two  in  one 
night. 

In  other  cases  there  is  a  condition  of  atony,  and  a  relaxed 
state  of  the  ejaculatory  ducts  and  gland,  when  an  emission 
may  take  place  without  creating  sufQcient  sensation  to 
arouse  one  from  sleep.  Again,  these  organs  may  be  so 
sensitive,  by  reason  of  these  lesions,  that  in  an  effort  at 
sexual  congress  there  is  a  premature  ejection;  even,  at 
times,  this  may  occur  before  intromission. 

There  is  frequently  a  prostatic  discharge,  that  is  mis- 
taken for  that  of  a  seminal  character.  These  chronic  dis- 
charges, from  whatever  source  they  may  arise,  rarely  cause 
noticeable  systemic  disturbances,  unless  they  are  very  ex- 
cessive. It  is  the  pathogenic  change  in  the  prostate  or 
vesicles,  that  depresses  the  nervous  system,  disturbs  diges- 
tion and  prevents  in  many  instances  proper  assimilation. 
Often  there  is  little  or  no  systemic  disturbance,  and  one 
may  remain  in  apparent  robust  health  for  a  long  time,  yet 
he  is  conscious  of  something  being  wrong  with  his  sexual 
organs.  There  are  others  whose  general  health  is  very 
much  impaired  as  result  of  disorders  of  these  organs,  yet 
have  few  subjective  symptoms  pointing  directly  thereto. 


SUBACUTE  OR  CHRONIC   PROSTATITIS.  49 

DIAGNOSIS. 

The  diseases  for  which  chronic  prostatitis  is  most  liable 
to  be  mistaken,  are  stricture  and  localized  urethritis.  The 
latter  two  may  either  succeed,  coexist  with  or  be  excitant 
causes  of  the  former. 

The  prostatic  urethra  is  the  most  common  site  of 
urethritis  and  is  pathognomonic  of  prostatitis.  As  or- 
ganic stricture  never  occurs  in  the  prostatic  urethra,  one 
familiar  with  passing  of  a  bulbous  bougie  can  easily  de- 
termine when  it  has  passed  the  membranous  and  entered 
the  prostatic  portion  of  the  canal.  This,  too,  can  be  de- 
termined by  the  length  of  the  channel  and  the  distance 
traversed  by  the  bougie.  Or,  the  operator  may  pass  the 
bougie  into  the  bladder,  and,  by  withdrawing  it,  measure 
the  distance  and  locate  the  points  where  it  meets  with  re- 
sistance or  roughness  at  the  entrance  of  the  prostatic 
urethra.  There  is  also,  at  the  point  of  roughness,  a  slight 
sensation  of  pain  or  irritation,  which  may  not  be  felt  at 
any  other  portion  of  the  canal,  or  if  at  all,  but  faintly. 

Owing  to  the  granulated  and  slightly  swollen  condition 
of  the  prostatic  urethra,  it  encroaches  to  some  extent  upon 
the  calibre  of  the  canal,  causing  some  narrowness.  This 
condition  may  be  mistaken  for  stricture.  Furthermore,  the 
channel  being  sensitive  at  an  inflamed  point,  and  the  con- 
tact of  the  instrument  with  the  mucous  membrane  thereat 
may  produce  reflex  contraction  of  the  circular  muscular 
fibers  simulating  stricture.  This  either  causes  a  grasping 
of  the  instrument  or  obstructs  its  passage  for  the  time. 
As  previously  stated,  if  an  instrument  of  small  size  is  used 
it  may  enter  the  orifices  of  the  ejaculatory  ducts  or  utricle, 
as  they  are  frequently  dilated  in  these  diseases,  and  becom- 
ing arrested  thereby,  create  the  impression  that  stricture 
exists.  I  have  known  such  mistakes  made  often  and 
urethrotomy  performed  therefor. 


50  PROSTATE  GLAND  AND  ADNEXA. 

The  first  morbific  change  that  occurs  within  the  prostate, 
is  chronic  catarrhal  folliculitis.  This  condition  may  last 
for  years,  under  strict  observance  of  hygienic  laws,  and 
temperate  habits  with  little  or  no  manifest  symptom  than 
that  of  an  occasional  or  persistent  gleety  discharge ;  or  the 
discharge  may  be  so  faint  as  to  become  desiccated  after 
reaching  the  urethra,  and  noted  by  shreds  in  the  first 
voiding  of  urine.  Subsequently  the  inflammatory  con- 
ditions extend  to  the  interior  of  the  gland  and  provoke 
interstitial  prostatitis,  causing  soft  infiltration  with  slight 
tumefaction  of  this  organ;  yet,  there  may  be  little  or  no 
local  or  systemic  disturbance,  unless  there  occurs  an 
abrasion  of  tissue  within  the  prostate,  when  the  toxins  or 
cocci  may  become  absorbed  and  engender  metastasis. 

It  is  quite  common  for  some  men,  as  influenced  by  these 
toxins,  to  become  emaciated  and  delicate  though  suffering 
no  pain  or  marked  constitutional  disturbance;  while  oth- 
ers remain  in  robust  appearance,  though  suffering  from 
metastasis,  or  pains  anywhere  from  that  of  the  back  of 
their  neck  to  their  heels.  Others  become  nervous  from  func- 
tional involvement  of  the  cerebro-spinal  centers,  causing 
melancholia,  impaired  memor}',  sciatica,  paraparesis  or 
many  other  forms  of  nervous  disturbances.  These  changes 
may  develop  so  insidiously  as  to  create  no  uneasiness  upon 
the  part  of  the  victim,  unless  the  vesicles  become  involved, 
or  the  inflammatory  conditions  encroach  uj)on  the  ejacula- 
tory  ducts,  narrowing  their  calibre  or  limiting  their  normal 
elasticity  to  the  extent  of  obstructing  the  passage  of  semen 
altogether;  or,  should  it  pass  through  these  narrow  chan- 
nels, during  sexual  congress,  it  would  be  followed  by  dull 
pain,  or  marked  nervous  depression. 

Long  standing  disease  of  the  gland  develops  a  congested 
state  and  inflammatory  complications  of  the  bladder,  rec- 
tum, vesicles,  and,  at  times,  the  kidneys,  but  the  latter 
are  rarely  affected  to  any  serious  extent. 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  51 

TREATMENT. 

Owing  to  tlie  diversity  of  symptoms,  botli  subjective  and 
objective,  and  the  complications  tliat  esist  with  individual 
cases,  it  is  obvious  that  the  treatment  must  necessarily  vary 
in  accordance  with  the  existing  pathologic  conditions  and 
indications.  It  is  therefore  impossible  to  establish  a  fixed 
rule,  by  which  to  be  governed  in  the  treatment  of  all  cases. 
I  can  give  here  only  a  general  outline  of  the  course  to  be 
adopted;  whereas  a  more  detailed  account  will  be  given  in 
the  clinical  reports  that  will  follow  hereafter. 

As  the  urethra  and  rectum  are  the  only  channels  through 
which  to  reach  the  prostate  for  direct  treatment,  these  must 
be  rendered  and  maintained  in  a  condition  as  free  from 
inflammation  or  irritation  as  possible.  As  the  larger  por- 
tion of  the  prostate  lies  between  and  in  contact  with  these 
two  canals,  it  would  be  impossible  to  relieve  the  gland  as 
long  as  these  remain  inflamed. 

Any  acrid  condition  of  the  urine,  whether  too  acid  or 
alkaline,  should  be  corrected.  As  before  stated,  in  this 
class  of  diseases  of  the  gland,  the  urine  seldom  requires 
special  attention,  since  the  bladder  or  kidneys  are  rarely 
affected. 

When  there  are  no  acute  symptoms  I  usually  give  fluid 
extract  of  Triticum  repens  to  render  the  urine  bland  and 
non-irritating.  When  over-acid,  potassic  citrate  may  be 
added  thereto  with  benefit.  There  rarely  exists  an  unduly 
alkaline  urine  in  these  cases,  but  when  such  is  present, 
and  attended  with  vesical  irritation,  cystogen  tablets — 
four  to  eight  daily — has  proven  invaluable  in  controlling 
this  state.  In  excessive  dysuria,  or  where  there  is  an  acute 
inflammatory  condition  of  the  prostate,  hyoscyamus  is  indi- 
cated until  all  acute  symptoms  are  relieved.  For  annoying 
priapism,  or  marked  erethism  of  the  genitalia,  bromide  of 
sodium,  administered  in  ten  or  fifteen  grain  doses  at  night. 


52  PROSTATE  GLAND  AND  ADNEXA. 

gives  temporal}^  relief,  until  cure  of  the  prostate  is 
effected. 

There  are  other  constitutional  remedies  that  are  espe- 
cially useful  in  individual  cases  towards  relieving  the 
annoying  symptoms  until  the  morbid  condition  of  the 
prostate  is  relieved.  So  much  has  been  said  and  written 
of  late  years,  regarding  the  use  of  cystogen  and  urotropin 
in  genito-urinary  diseases,  that  these  drugs  are  given  in  a 
routine  way  without  reference  to  their  specific  action. 
"While  they  have  the  property  of  correcting  the  excessive 
alkalinity  of  the  urine  in  some  cases,  yet  the  liberation  of 
formaldehyd  in  the  urine  is  very  irritating  to  the  urinary 
passages,  and,  if  they  are  prolonged  any  length  of  time, 
engender  much  vesical  disturbance,  dysuria  and  frequent 
micturition. 

"Staphisagria,  thuja  or  oil  of  wintergreen  in  doses  of 
from  one  to  ten  minims  each,  three  to  four  times  daily,  are 
about  the  best  remedies  that  can  be  used  in  chronic 
catarrhal  conditions  of  the  mucosa  of  the  bladder  or  ure- 
thra. These  three  may  be  combined  with  marked  benefit. 
They  should  be  given  highly  diluted." 

Eadical  treatment  of  the  gland  should  be  delayed  until 
all  acute  symptoms  of  the  urethra  are  allayed;  unless,  as 
in  some  cases,  there  is  urgent  necessity  for  immediate  re- 
lief, or  certain  conditions  of  the  gland  provoke  a  continuous 
urethritis. 

In  the  large  proportion  of  prostatic  diseases  urethritis 
coexists,  which  generally  aggravates  the  trouble.  To  allay 
the  sensitiveness  of  the  urethra,  I  begin  with  the  use  of  a 
three  per  cent  solution  of  argyrol  in  distilled  water, 
injected  with  an  ordinary  gonorrheal  syringe,  of  large  size. 
This  is  forced  into  the  deep  urethra  or  even  bladder. 
Should  a  copious  purulent  discharge  coexist,  one  grain  of 


SUBACUTE  OR  CHRONIC  PROSTATITIS. 


53 


sulpho-carbolate  of  zinc  to  the  ounce  is  added  thereto.  I 
not  only  avoid  instrumentation  until  all  acute  urethritis 
has  subsided,  but  often  defer  my  examination  where  sub- 
jective symptoms  indicate  such  condition,  until  the  acute 
symptoms  have  been  allayed.  The  invariable  result  is  re- 
duction of  the  inflammation  and  relief  of  the  tenderness, 
so  that  a  bougie  may  be  introduced  without  pain.  After 
the  injection  has  been  used  from  two  to  three  days  and  all 
acute  sensation  in  the  urethra  has  disappeared,  I  then 
insert  a  soft  flexible  bougie,  previously  annointed  with  an 


Fig.   VIII.  Fig.  IX. 

oil  composed  of  one  part  of  oil  of  eucalyptol  to  eight  of 
benzoinol.  As  the  sensation  in  the  urethra  diminishes  the 
proportion  of  eucalyptol  can  be  increased  until  it  stings 
sharply.  This  combination  so  applied  makes  a  stimulating 
yet  soothing  application  to  the  canal.  The  bougie  retains 
sufficient  of  the  remedy  to  apply  thoroughly  to  the  entire 
mucous  surface.    The  application  should  not  be  used  more 


54  PROSTATE  GLAND  AND  ADNBXA. 

often  than  every  second  day,  or  in  case  of  great  tenderness, 
every  third  day.  The  injection  can  be  continued  at  the 
same  time  until  the  acute  symptoms  have  completely  sub- 
sided. I  generally  use  this  treatment  from  one  to  two 
weeks,  or  in  some  rare  instances  longer  before  beginning 
the  radical  treatment.  Before  proceeding  with  the  latter, 
I  shall  describe  briefly  my  instruments,  together  with 
their  modes  of  application. 

Figures  VIII  and  IX  illustrate  instruments  devised  by 
the  author  for  the  special  treatment  of  prostatic  diseases. 
The  central  part  of  the  instrument  is  metallic,  and  in- 
sulated throughout  its  length,  except  at  the  curved  ex- 
tremity (as  shown)  and  the  point  to  which  the  cord  is 
attached.  A  rubber  bulb  is  fitted  over  the  other  hollow 
end.  The  exposed  part  of  the  metal  at  the  end  is  per- 
forated, so  that  when  the  instrument  is  immersed  in  any 
liquid  medicine  and  the  bulb  is  pressed,  then  relaxed,  it 
partially  fills;  when  the  bulb  is  again  pressed  the  medi- 
cine is  forced  out  in  jets  through  the  small  openings,  as 
illustrated.  No.  IX  is  used  to  apply  the  remedies  to  the 
prostatic  urethra  and  neck  of  the  bladder;  but  as  the 
greatest  trouble  exists  upon  the  floor  of  the  urethra  and 
within  the  ejaculatory  and  prostatic  ducts,  instrument  No. 
VIII  is  used,  as  shown  by  reference  to  Fig.  X. 

In  the  two  conditions  illustrated  by  plates  VI.  and  XII. 
cataphoresis  through  the  rectum  and  prostatic  urethra,  as 
shown  by  figures  X.  and  XI.,  is  especially  indicated.  In  the 
latter  the  medicine  is  introduced  through  the  curved,  cup- 
shaped  opening  at  the  lower  extremity,  and,  by  means  of 
a  rubber-tipped  syringe  it  is  forced  out  through  the  open- 
ings at  the  other  end,  as  indicated.  The  electric  current 
and  the  medicine  being  limited  to  that  part  immediately 
opposite  the  prostate  are  transmitted  to  the  gland  by  cata- 
pnoric  action. 


SUBACUTE  OR  CHRONIC  PROSTATITIS  55 


Fig.  X. 

By  passing  the  electrode  further  up  the  rectum  the 
same  cataphoric  action  is  exerted  upon  the  vesicles  when 
they  are  involved.  , 

The  instruments  are  so  constructed  as  to  meet  all  indi- 
cations for  applying  medicine  directly  to  localized  ulcers, 
or  granulated  patches,  along  the  urethral  canal,  and  effect 
cataphoresis,  interstitial  electrolysis,  vasomotor  contrac- 
tion, etc. 

It  must  be  remembered,  however,  that  the  properties  of 
the  currents  and  remedies  as  used  are  limited  to  their  ex- 
posed metal  ends  and  only  within  an  area  of  a  few  inches 


5S  PROSTATE  GLAND  AND  ADNEXA. 

therefrom  and  dependent  upon  the  strength  of  current. 
As  the  metal  part  (Fig.  VIII)  is  in  apposition  to  the  floor 
of  the  prostatic  urethra,  the  full  influence  of  the  current, 
for  whatever  purpose  used,  is  concentrated  upon  that  por- 
tion of  the  gland  tunneled  hy  the  ejaculatory  and  prostatic 
ducts,  and  the  parts  that  are  always  affected  in  this  dis- 
ease. The  strength  of  the  current,  therefore,  as  well  as 
the  remedy,  when  used  for  cataphoresis,  should  be  very 
mild. 

For  topical  applications  or  cataphoresis  the  alcohol  con- 
tained in  tinctures  or  fluid  extracts  is  too  irritating,  so  I 
always  use  aqueous  extracts,  when  using  organic  sub- 
stances. For  cataphoresis  I  prefer,  in  most  instances,  or- 
ganic preparations  to  those  of  inorganic,  as  the  latter  are 
more  rapidly  decomposed,  do  not  penetrate  the  tissues,  as 
do  the  organic  by  electric-osmosis,  and  produce  interstitial 
electrolysis  or  their  germicidal  effects  upon  the  micro- 
organisms when  such  are  suspected 

For  anodal  cataphoresis  a  non-oxidizable  electrode 
should  always  be  used,  or  the  electro  negative  elements 
will  combine  with  it  and  form  new  compounds,  which  may 
be  very  irritating  or  wholly  inert.  An  oxidizable  electrode 
may  be  used  in  some  instances  with  advantage  to  effect 
metallic  cataphoresis,  when  the  result  of  such  combination 
and  its  properties  are  known.  As,  for  instance,  the  anodal 
use  of  a  copper  electrode  results  in  the  formation  of  oxy- 
chloride  of  copper,  which  would  be  transfused  throughout 
the  gland  and  be  of  marked  benefit  in  some  cases.  On  the 
other  hand,  should  a  brass  electrode  be  similarly  used,  a 
double  combination  would  result  and  the  formation  of 
chloride  of  zinc  would  be  very  painful. 

The  treatment  of  cases  of  gonorrheal  origin  should  be 
somewhat  different  from  those  due  to  other  causes.  In 
the  former,  germicidal  remedies  should  be  used,  although 


SUBACUTE  OR  CHRONIC  PROSTATITIS. 


57 


I  have  clinically  demonstrated  in  many  instances  phago- 
cytosis by  the  attraction  of  leucocytes,  and,  aided  by  the 
lethal  effect  of  cataphoresis,  all  evidence  of  the  germs  dis- 
appear. The  cathodal  attraction  of  blood  serum  is  of  easy 
demonstration,  both  within  and  outside  of  the  bodv. 


Fig.  XI. 

Let  a  non-oxidizable  electrode  be  attached  to  the  anode 
and  passed  into  the  urethra,  and,  even  with  a  mild  current, 
it  will  soon  become  glued  to  the  parts ;  when,  by  reversing 
the  poles  the  cathodal  attraction  of  serum  will  loosen  it 
very  quickly.  The  experiment  may  be  made  by  applying 
the  poles  in  a  similar  way  to  a  fresh  beefsteak,  when  moist- 


68  PROSTATE  GLAND  AND  ADNEXA. 

are  will  rapidly  accumulate  on  the  cathodal  side,  while 
the  opposite  side  will  become  desiccated. 

The  electrolytic,  cataphoric  and  dynamic  properties  of 
the  different  currents  are  indisputable.  These  properties 
can  be  used  to  effect  synthetic  or  dialytic  changes  in  both 
organic  and  inorganic  substances;  exert,  by  attraction  and 
repulsion,  oscillation  of  molecules  of  bodies ;  and  trans- 
fuse liquids  through  animal  tissue.  While  these  agents 
can  be  applied  to  destroy  micro-organisms,  dissipate  mor- 
bific tissue  and  invigorate  the  atonic  organs ;  yet  they  can- 
not be  used  without  due  reference  to  the  condition  of  the 
parts,  the  selection  of  the  proper  current  and  remedy  to 
be  used  therewith,  intervals,  strength  and  length  of  time 
to  be  effectual  and  not  engender  harm. 

Before  the  parts  can  be  restored  to  a  healthy  state,  the 
morbid  tissue  or  unhealthy  granulations  must  be  removed. 
The  most  satisfactory  way  by  which  this  can  be  accom- 
plished, without  direct  or  ultimate  bad  results,  is,  in  my 
opinion,  by  electrolysis  or  cataphoresis,  accompanied  with 
suitable  medicinal  remedies.  Nitrate  of  silver  has  been  in 
use  for  that  purpose  from  time  immemorial,  but  it  causes 
excessive  pain,  fails  to  penetrate  the  ducts  and  gland,  and 
is  often  followed  by  cystitis,  prostatis  or  epididymitis.  The 
patient  is  often  confined  to  bed  for  weeks,  and,  on  recover- 
ing, is  visited  anew  by  the  same  trouble;  which  persists  in 
a  chronic  condition,  as  before.  Moreover,  the  nerves,  ves- 
sels, follicles  and  parenchyma  of  the  gland  lack  vitality 
and  recuperative  power,  and,  even  after  the  morbid  prod- 
ucts have  been  removed,  require  the  invigorating  influence 
of  the  current  in  order  to  bring  about  healthy  granula- 
tions and  a  restoration  of  the  organs  to  their  normal  state. 

The  most  satisfactory  method  of  treating  these  organs 
is  to  thoroughly  examine  them  with  the  cystoscope,  and 
locate  the  ulcerated  patches  within  the  urethra,  see  defi- 


SUBACUTE  OR  CHRONIC   PROSTATITIS.  59 

nitely  the  condition  of  the  prostate  and  bladder.  Then 
the  treatment  can  be  applied  directly  to  the  diseased  parts. 
It  is  only  after  all  the  acute  symptoms  have  been  allayed 
by  the  methods  heretofore  detailed,  that  the  electric  treat- 
ment should  be  used. 

As  ultimate  results  depend  largely  upon  the  proper  se- 
lection, control  and  application  of  the  currents,  as  well 
as  upon  the  suitable  remedies  to  be  used  in  connection 
therewith,  I  shall  take  it  for  granted  that  the  reader,  be- 
fore proceeding  further  with  the  detailed  electric  treat- 
ment that  follows,  is  thoroughly  familiar  with  the  subjects 
of  electro-physics,  electrolysis  and  cataphoresis  as  described 
in  Chapter  VIII. 

Before  beginning  electric  treatment,  the  operator  should 
carefully  examine  the  battery  and  conducting  cords,  to  as- 
certain whether  the  former  is  in  perfect  working  order,  and 
the  latter  are  intact  and  connected  with  the  proper  poles. 
The  latter  he  should  frequently  test  in  order  to  be  certain 
as  to  their  proper  applications.  This  may  seem  an  excess 
of  caution,  but  if  the  operator  himself  was  being  treated, 
and  had  experienced  the  result  of  forgetting  to  turn  off 
one  switch,  or  turn  on  another,  or,  still  more  important, 
to  note  carefully  the  position  of  the  commutator,  he  would 
agree  that  these  points  can  not  be  too  forcibly  impressed. 
Even  now,  after  many  years  of  experience  in  manipulating 
all  kinds  and  makes  of  batteries  and  accessories,  I  never 
fail  to  use  these  precautions. 

In  using  the  galvanic  current  for  electrolysis  or  cata- 
phoresis, it  is  important  never  to  shock  the  patient.  Al- 
though probably  no  harm  would  result,  yet  the  patient 
would  always  be  in  fear  of  a  repetition  of  the  shock,  even 
if  he  did  not  discontinue  treatment  altogether.  To  avoid 
this,  a  large  sponge  or  carbon  electrode,  about  eight  inches 
in  diameter,  is  attached  to  the  cord  (which  is  previously 


60  PROSTATE  GLAND  AND  ADNBXA. 

connected  with  the  indifferent  pole  of  tlie  battery),  and 
•  placed  within  easy  reach  of  the  patient — preferably  upon 
the  stomach — that  both  hands  may  be  used  if  necessary. 
The  active  electrode  is  then  placed  in  position  for  treat- 
ment, and  the  cord  attached  thereto.  Up  to  this  time  the 
patient  has  not  been  allowed  to  touch  the  sponge,  or  in- 
different electrode,  with  his  hands.  He  is  then  instructed 
how  to  touch  it  gently  with  the  fingers  of  one  hand,  and 
gradually  bring  them  down  until  the  palm  is  flat  upon  it. 
Should  it  be  desirable  to  increase  the  efficiency  of  the  ac- 
tive electrode,  the  other  hand  can  be  placed  iipon  the 
sponge  in  the  same  way.  The  greater  the  surface  of  the 
indifferent  electrode,  the  greater,  in  direct  proportion,  is 
the  efficacy  of  the  active  electrode.  Before  removal  of  the 
latter,  the  hands  should  first  be  removed,  in  the  same  man- 
ner as  they  were  applied.  Should  it  be  necessary  to  re- 
verse the  poles  during  the  treatment,  by  means  of  the  com- 
mutator, or  in  any  way,  have  the  hands  removed  first  and 
then  replaced  in  the  same  manner  as  before  described.  By 
observing  these  precautions  there  will  be  no  shock. 

A  battery  should  be  so  constructed  that  the  current  can 
be  gradually  increased  from  the  minimum  to  the  desired 
strength  without  interrupting  the  circuit.  The  suscepti- 
bility of  individual  cases  varies  so  greatly  that  I  would  al- 
ways advise  the  use  of  the  mildest  current  and  the  shortest 
duration  during  the  first  few  treatments.  Whenever  there 
is  an  indication  of  pain,  the  treatment  should  be  discon- 
tinued at  once.  I  rarely  use  local  anesthesia,  even  in  the 
case  of  nervous  patients  with  excessively  hyperesthetic 
urethras.  The  sensation  is  one  of  the  best  guides  to  the 
strength  of  the  current  to  be  used,  and  the  length  of  time 
it  is  to  be  continued. 

We  must  bear  in  mind  the  objects  to  be  accomplished 
by  treatment,  viz.,  the  removal  of  morbid  products  and  the 


SUBACUTE  OR  CHRONIC   PROSTATITIS.  61 

relief  of  passive  congestion  by  stimulating  vasomotor  con- 
traction, thereby  reducing  inflammation.  These  can  be 
obtained  without  producing  undue  pain.  Pain  causes  con- 
gestion and  inflammation,  and  it  is  impossible  to  state 
just  how  many  volts  or  milliamperes  should  be  used  in  the 
beginning  or  at  any  time  during  the  treatment.  A  current 
of  sufiicient  strength  to  relieve  one  patient  might  be  inert 
in  a  second  case  or  even  harmful  to  a  third.  I  begin  with 
from  five  to  ten  volts  in  the  circuit,  and  never  occupy  more 
than  three  or  four  minutes  during  the  first  or  even  second 
treatment.  Most  beginners,  and,  in  truth,  nearly  all,  with 
whose  work  I  am  familiar,  try  to  do  too  much,  and  in  too 
short  a  time. 

As  to  the  selection  of  an  instrument,  I  rarely  use  an 
electrode  smaller  than  No.  14  A,  which,  unless  there  is  a 
stricture,  passes  readily  into  the  prostatic  urethra,  and 
thence  into  the  bladder,  without  engaging  the  openings 
upon  the  floor  of  the  prostatic  urethra.  I  always  begin  the 
electric  treatment  by  using  the  electrode,  as  illustrated  by 
Fig.  IX.  With  this  I  denude  the  prostatic  urethra  of  the 
unhealthy  granulations,  by  means  of  cathodal  applications. 
These  treatments  are  never  made  of  tener  than  on  alternate, 
or,  more  frequently,  third  days.  In  some  highly  sensitive 
cases  I  allow  a  week  to  elapse  between  treatments,  and  use 
a  bougie  with  benzoinol  ointment,  in  the  interval.  It  gen- 
erally takes  from  three  to  five  treatments  to  remove  all  the 
granulations,  which  can  be  detected  in  the  urine,  if  passed 
in  a  bottle,  for  two  or  three  days  after  each  treatment. 

In  making  a  cathodal  treatment,  the  kind  of  metal  used 
upon  the  point  of  the  electrode  is  a  matter  of  indifference, 
as  the  electro-positive  elements  do  not  affect  it.  But  in 
anodal  treatment  the  electro-negative  elements,  as  oxygen, 
acids,  etc.,  combine  with  most  metals  very  readily.  In 
thcbe  I  always  use  an  electrode  of  platinum  or  gold  point; 


63  PROSTATE  GLAND  AND  ADNBXA. 

unless  I  wish  to  procure  a  local  effect  by  means  of  the 
metallic  combination  with  the  elements.  For  example, 
after  denuding  the  prostatic  urethra  of  the  granulations, 
in  order  to  bring  about  healthy  action,  I  often  make  an 
anodal  application  with  an  electrode  having  a  solid  copper 
point,  with  very  happy  results.  The  action  of  the  acids 
of  the  electrolytes  upon  the  metaL  together  with  the  tonic 
effect  of  the  anode,  brings  about  renewed  vigor  of  the  tis- 
sues. Those  new  combinations  also  penetrate  the  gland 
by  cataphoric  action  and  have  the  same  healthy  effect  upon 
it. 

The  selection  of  remedies  to  be  used  by  cataphoresis 
Mathin  the  ducts  and  upon  the  follicles  and  gland,  must 
be  made  with  reference  to  the  electrolytic  effect  of  the  cur- 
rent. As  water  and  salt  enter  largely  into  the  composition 
of  animal  tissue,  free  oxy-chloride  can  alwa3-s  be  expected 
in  an  anodal  application. 

So  complex  are  the  chemic  constituents  of  many  reme- 
dies, the  electrolytic  effect  of  the  current  upon  them,  and 
the  recombinations  resulting  from  the  union  of  the  electro- 
negative elements  with  reference  to  their  relative  affinity, 
that  in  many  instances,  it  is  difficult  to  determine  exactly 
what  the  changes  are  and  the  combinations  formed  thereby. 

The  frequency  with  which  urethral  instrumentation 
should  be  used  depends  upon  the  condition  of  both  the 
prostate  and  urethra.  Should  the  inflammation  and  su- 
persensitiveness  of  the  canal  have  been  greatly  allayed  by 
injections  and  bougies,  as  before  described,  then  electrolysis 
or  cataphoresis  can  be  employed  every  fourth  or  sixth  day, 
alternating  with  the  use  of  the  bougie  the  second  or  third 
day.  The  interval  between  the  use  of  the  bougie  and  that 
of  the  electrode  should  either  be  two  or  three  days,  depend- 
ing upon  the  sensitiveness  of  the  urethra  and  prostate. 
Should  tenderness  of  the  canal  still  continue,  the  injec- 


SUBACUTE  OR  CHRONIC   PROSTATITIS.  63 

tion  should  be  used  uninterruptedly.  In  some  instances 
urethral  instrumentation  should  be  used  only  once  a  week. 

The  advice  of  Sir  Henry  Thompson  in  this  connection 
is  very  valuable  and  should  be  rigidly  observed.  He  says : 
*'Eemember  that  the  introduction  of  an  instrument  is  more 
or  less  of  an  evil  never  to  be  resorted  to  unless  a  greater 
evil  be  present  which  its  employment  may  probably  rem- 
edy." 

It  is  always  better  to  err  upon  the  conservative  side,  and 
to  do  too  little  rather  than  too  much.  There  is  one  other 
point  of  special  importance  that  I  wish  to  impress  forcibly 
upon  the  minds  of  my  readers — one  that  I  learned  by  obser- 
vation— and  it  is  this :  after  a  patient  has  been  treated  for 
some  four  to  eight  weeks  in  succession  it  is  better,  in  the 
majority  of  cases,  to  discontinue  all  treatment  for  one, 
two  or  even  three  weeks.  This  is  in  order  to  give  "vis 
medicatrix  naturae"  a  chance,  and  to  rid  the  gland  of  the 
disintegrated  products  which  result  from  interstitial 
changes,  as  caused  by  electrolysis  or  cataphoresis.  In  the 
large  majority  of  cases  the  improvement  is  more  marked 
than  if  the  treatment  had  been  uninterrupted.  This  fact 
was  noted  in  many  instances  where  I  was  treating  men 
who  lived  at  a  distance,  and  who  had  to  return  to  their 
homes  on  account  of  business  or  for  other  reasons.  On 
their  return  I  would  find  great  improvement ;  and  in  many 
instances  complete  recovery  would  result,  which  obviated 
the  necessity  of  a  return  for  further  treatment. 

Much  depends  upon  the  caution  and  skill  of  urethral  in- 
strumentation. I  think  it  would  be  well  for  many  physi- 
cians to  adopt  the  suggestion  of  Sir  Henry  Fenwick  (sur- 
geon to  the  London  Hospital),  where  he  says  to  his  assis- 
tants :  "Every  dresser  should  be  induced  to  pass  a  full 
sized  steel  bougie  upon  himself  once  or  twice.  Ho  would 
then  appreciate  the  need  of  the  utmost  gentleness  in  ure- 


64  PROSTATE  GLAND  AND  ADNEXA. 

thral  instrumentation."  I  have  seen  much  harm  result 
from  the  injudicious  use  and  rough  handling  of  instru- 
ments in  the  treatment  of  the  prostate  gland. 

The  treatment  I  have  detailed  does  not  interfere  with 
the  patient's  daily  business.  But,  on  the  contrary,  he  be- 
gins to  feel  better  and  fitter  for  work  in  a  few  days  after 
the  treatment  is  begun. 

I  invariably  interdict  the  use  of  alcoholic  drinks,  and 
especially  beer  or  fermented  wines,  during  treatment;  as 
they  have  a  tendency  to  increase  local  congestion  and  in- 
flammation, and,  besides,  cause  increased  precipitation  of 
uric  acid.  I  do  not  otherwise  restrict  the  diet,  in  the  ma- 
jority of  cases. 

Fig.  Xlla  illustrates  an  instrument  devised  by  the 
author  for  the  special  purpose  of  treating  and  diagnosing 
any  ulcerated  surface  anywhere  along  the  urethral  canal, 
from  the  meatus  to  the  neck  of  the  bladder;  and  even 
prostate.  I  use  this  instrument  and  Fig.  IX  on  page  53 
r.iore  than  any  other.  In  fact,  they  are  indispensable  to 
any  physician  who  has  to  treat  any  cases  of  chronic  dis- 
eases of  the  urethra  or  prostate  gland.  To  use  this  instru- 
ment properly,  first  allay  all  acute  s}Tiiptoms,  as  detailed 
on  pages  51,  etc.  The  next  step  is  to  have  the  patient 
void  his  urine  and  lay  in  recumbent  posture  with  hips 
elevated.  He  will  thus  avoid  having  urine  to  dilute  or 
neutralize  the  medicine,  and  the  effect  of  the  application 
will  be  similar  to  applying  a  remedy  to  an  ulcer  outside 
the  body.  Then  make  a  local  application  of  from  five  to 
ten  per  cent  of  eucaine  or  cocaine  to  the  deep  urethra 
with  instrument  ISTo.  IX,  page  53;  after  awaiting  five 
minutes  to  anesthetize  the  deep  urethra,  which  is  the  most 
sensitive  part,  place  the  ends  of  two  wooden  applicators  in 
a  glass  of  water,  then  reverse  and  immerse  the  other  ends 
of  the  applicators.  After  these  are  thoroughly  wet,  twist 
a   small   piece   of    absorbent   cotton   on   each   end   of  the 


PROSTATE  GLAND  AND  ADNEXA. 

applicators,  as  illustrated  Fig.  Xllla.  It  is  important  to 
have  the  sticks  thoroughly  wet  or  the  cotton  might  become 
detached  from  the  stick  and  become  lodged  within  the 
urethra.  The  next  step  is  to  insert  the  obturator  in  the 
tube,  then  pass  instrument  slowly  down  the  urethra  until 
the  end  enters  the  neck  of  the  bladder,  when  withdraw  the 
obturator  and  insert  the  applicator  with  the  cotton,  as 
shown  by  Fig.  Xlllb ;  withdraw  the  latter  and  look  at  the 
cotton  and  note  whether  it  is  bloody.  Move  the  tube  a 
little  at  a  time,  first  deeper,  then  withdraw  until  you  note 
blood  upon  the  cotton,  which  indicates  an  ulcer,  or  granu- 
lar patch;  then  insert  other  end  of  the  cotton  applicator 
with  whatever  medicine  may  be  desired  to  treat  the  ulcer 
or  granular  patch.  I  use  for  this  purpose  from  two  to  five 
per  cent  solution  of  picratol,  argyrol,  petrogen,  thallin,  etc. 
Case  I. — Chronic  Prostatitis  and  Prostatic  Ure- 
thritis. 

Aged  twenty-four;  single;  history,  as  given  by  himself, 
is  as  follows:  "When  eighteen  he  had  gonorrhea  which 
lasted  about  nine  months.  During  the  first  stages  of  the 
disease  dysuria  was  excessive,  the  discharge  from  the  ure- 
thra being  very  copious,  and  followed  by  vesical  tenes- 
mus, chordee,  etc.  He  had  several  succeeding  attacks, 
which  lasted  only  a  few  weeks,  during  which  time  there 
was  but  little  pain  or  disturbance  of  any  character.  A 
gleety  discharge  followed,  continuing  up  to  his  twenty- 
first  year,  when  he  was  pronounced  strictured,  and  treated 
for  such  by  means  of  steel  sounds.  The  treatment  was 
very  painful  and  at  first  followed  by  bloody  discharges. 
This  was  continued  for  about  a  year,  during  which  time 
there  was  a  continuous  gleety  discharge.  His  health  was 
much  impaired;  there  was  a  dull  aching  sensation  in  the 
region  of  the  perineum,  especially  when  walking  or  stand- 
ing. He  changed  physicians;  sounds  were  used  as  before, 
but  larger,  and  producing  hemorrhage  attended  with  great 

64a 


Pig   Xlla, 


Fig.  Xllb. 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  65 

pain.  His  health  continued  to  grow  worse;  he  became  very 
thin;  suffered  with  anorexia,  emissions  and  weakness  of 
the  sexual  organs,  dull  headache,  despondency  and  lack  of 
confidence. 

Upon  examination  I  found  the  meatus  red,  inflamed, 
and  the  lips  glued  together.  There  was  a  granular  ulcer 
in  the  fossa  navicularis  about  an  inch  behind  the  glans 
penis.  On  the  introduction  of  a  bougie  a  hoiile,  there  was 
little  sensitiveness  of  the  urethra  until  the  prostatic  por- 
tion was  reached,  where  roughness  offered  a  slight  resist- 
ance to  the  passage  of  the  instrument,  indicating  a  granu- 
lar ulceration,  and  extreme  tenderness.  On  withdrawal  of 
the  instrument  pus  and  mucus  were  found  adhering  to  it. 
Microscopical  examination  did  not  reveal  any  gonococci. 
Upon  pressure  through  the  rectum  there  was  very  slight 
tenderness  of  the  gland  and  little  or  no  swelling. 

TREATMENT. 

On  the  second  day  after  the  examination  I  made  an 
application  of  ointment  composed  of  the  oil  of  eucalyptol 
one  part  to  benzoinol  eight.  This  was  repeated  on  the 
third  day  thereafter,  when  there  was  some  less  tenderness. 
Two  days  afterwards  the  ointment  was  again  applied  and 
the  tenderness  became  still  less  apparent.  Three  days 
thereafter  treatment  by  electrolysis  was  instituted,  by 
means  of  jSTo.  14  electrode,  with  five  m.a.,  lasting  three 
minutes.  There  was  at  the  time  a  slight  stinging  sensa- 
tion, followed  by  a  mild  mucopurulent  discharge.  On  the 
second  day  an  injection  was  given,  one  grain  of  sulpho- 
carbolate  of  zinc  to  one  ounce  of  a  ten  per  cent  solution 
of  argyrol,  to  be  used  four  times  daily.  On  the  third 
day  after  the  electric  treatment  the  ointment  was  again 
used,  the  injection  being  continued  in  the  interim.  The 
discharge  became  less,  and  three  days  afterwards  electroly- 


66  PROSTATE  GLAND  AND  ADNBXA. 

sis  was  again  applied  with  eight  m.a.,  for  three  minutes; 
slight  watery  discharge  followed  the  treatment.  Small 
granules  and  shreds  were  noticeable  in  the  urine.  There 
followed  an  improvement  in  every  respect;  discharge 
scarcely  perceptible.  Cataphoresis  was  now  applied 
through  instrument  No.  VIII,  with  five  per  cent  solution 
of  argyrol,  ten  m.  a.,  for  five  minutes;  slight  sensation, 
little  irritation  following.  The  case  was  treated  thereafter 
by  means  of  cataphoresis  (a  one  per  cent  solution  of  thuja 
— Aqueous — ^being  used),  an  ointment,  alternating  every 
third  day  for  one  month.  Treatment  was  then  discontin- 
ued for  ten  days,  when  patient  returned  feeling  greatly 
relieved;  no  discharge,  cataphoresis  used  with  thuja,  one 
per  cent  strength,  ten  m.a.,  three  minutes,  causing  slight 
stinging;  no  ill  effects  following.  Ten  per  cent  solution 
of  argA^rol  was  applied  in  the  same  way  to  the  fossa 
navicularis.  The  patient  was  then  treated  once  a  week  by 
means  of  cataphoresis,  with  twenty  per  cent  strength  of 
verbascum  for  a  month,  when  he  was  discharged — cured. 
This  case  was  under  observation  for  several  years  after 
dismissal  and  there  was  never  any  symptom  of  the  former 
trouble.  In  regard  to  the  remedies  used  I  may  state  that 
thuja  is  a  non-alcoholic  extract  of  arbor  vitse,  which  I 
have  specially  prepared  for  me.  The  alcohol  contained  in 
tinctures  is  too  irritating,  unless  well  diluted,  when  the 
resin  in  thuja  is  precipitated,  and  the  medicine  is  ren- 
dered inert. 

Case  II. — Prostatitis,  Stricture. 

Gonorrhoea!  history  of  seven  years  standing,  with  fre- 
quent recurrences;  gleet  constant.  Patient  had  stricture 
in  the  membranous  urethra,  six  and  one-half  inches  from 
the  meatus — ^caliber  12  A.  Immediately  back  of  the  stric- 
ture and  extending  through  the  prostatic  urethra  was  a 


SUBACUTE  OR  CHRONIC   PROSTATITIS.  67 

granulated  ulcer.  There  was  apparently  no  obstruction 
to  the  flow  of  urine  nor  pain  during  the  time,  but  at  the 
close  of  the  act  there  would  be  slight  pain  and  dribbling 
of  urine,  lasting  from  three  to  five  minutes.  At  times  a 
milky  discharge  preceded  the  flow.  This  preyed  upon  his 
mind,  as  he  believed  it  was  spermatorrhea,  for  which,  as 
he  said,  "he  had  taken  barrels  of  medicines."'  He  was 
troubled  with  sexual  and  moral  hyperesthesia,  insomnia 
and  hypochondriasis.  The  discharge  proved  to  be  a  per- 
verted prostatic  secretion  containing  also  mucus  and  pus 
cells.  He  was  in  good  flesh,  though  pale  and  easily  tired 
upon  exertion.  Sexual  relations  were  very  erratic.  At 
times  several  weeks  would  pass  without  the  least  desire  or 
even  erection.  Then  again  there  would  be  an  almost  insati- 
able propensit}',  but  in  attempting  the  act  ejection  would 
occur  before  intromission,  followed  by  a  dull  aching  in 
the  region  of  the  perineum. 

Applications  of  benzoinal  ointment  were  made  on  alter- 
nate days  three  times.  On  the  second  day,  after  the  last 
ointment  treatment,  electrolysis  was  applied  to  the  stric- 
ture, a  14  A.  electrode  having  been  attached  to  the  cathode. 
The  strength  of  the  current  was  gradually  increased  from 
five  to  twelve  m.a.,  for  five  minutes,  when  the  electrode 
passed  the  stricture.  There  was  no  pain  until  the  stricture 
was  passed,  and  the  electrode  came  in  contact  with  the 
granulated  ulcer  behind  it,  which  was  very  sensitive  and 
somewhat  painful.  The  circuit  was  immediately  broken 
and  the  electrode  withdrawn.  On  the  third  day  thereafter 
a  bougie  ISTo.  12  A.  was  introduced,  and  passed  easily  into 
the  bladder.  Three  days  afterwards  electrolysis  was  again 
applied  in  the  same  manner  as  before  with  five  m.a.,  for 
three  minutes.  The  electrode  entered  the  bladder  without 
resistance,  and  with  very  little  sensation.  This  was  fol- 
lowed as  usual  by  a  slight  muco-purulent  discharge.    Cata- 


68  PROSTATE  GLAND  AND  ADNEXA. 

phoresis  was  then  instituted  with  one  per  cent  strength  of 
Ichthyol  every  fourth  day  for  three  weeks.  Complete  re- 
covery resulted. 

Case  III. 

Single;  aged  thirty-four;  consulted  me  for  "nervous- 
ness." He  had  been  a  very  successful  business  man,  hav- 
ing charge  of  a  large  force  of  men  in  an  extensive  estab- 
lishment. He  was  naturally  very  reticent  with  men  and 
timid  with  women. 

He  had  never  had  any  venereal  disease,  and  in  fact  had 
no  subjective  symptoms  of  sufficient  importance  to  justify 
an  examination  of  the  genital  organs.  Thinking  that  close 
attention  to  business  and  long  sustained  tax  of  his  mental 
powers  had  given  rise  to  the  disturbance  of  which  he  com- 
plained, I  advised  complete  rest,  and  at  the  same  time  giv- 
ing him  a  tonic,  as  he  was  somewhat  anemic,  though  in 
good  flesh.  He  left  my  office  in  good  spirits,  intending  to 
spend  a  month  or  two  in  the  Cumberland  Mountains,  fish- 
ing and  hunting.  In  about  ten  days,  to  my  surprise,  he 
returned,  saying  that  he  believed,  had  he  remained  up 
there  a  week  longer,  he  would  have  gone  crazy ;  that,  while 
he  was  away,  he  did  not  think  he  had  averaged  two  hours' 
sleep  in  the  twenty-four,  and  having  nothing  to  do  but 
to  think  of  himself  and  his  condition  made  him  worse  than 
when  at  work.  The  objective  symptoms,  as  revealed  by  an 
examination,  showed  an  excessively  hyperesthetic  urethra, 
so  much  so  that  the  introduction  of  a  soft  bougie  caused 
him  to  partially  swoon  and  break  out  into  profuse  prespira- 
tion.  He  was  allowed  to  remain  upon  the  table,  in  recum- 
bent position,  for  half  an  hour,  when  he  fully  recovered, 
saying  that  the  instrument  did  not  pain  him  very  much, 
but  that  it  caused  a  peculiar,  indescribable  sensation  that 
rushed  to  his  head  and  caused  blindness.     The  night  fol- 


SUBACUTE  OR  CHRONIC   PROSTATITIS.  69 

lowing  he  had  the  best  sleep  that  he  had  experienced  for 
six  months.  I  had  him  inject  a  ten  per  cent  solution  of 
argyrol  three  times  daily  for  a  week  in  order  to  allay 
the  hyperesthetic  condition  of  the  urethra  before  proceed- 
ing further  with  the  examination. 

Upon  questioning  him  further  upon  the  subject,  I  was 
alile  to  elicit  from  him  the  fact  that  in  his  early  youth  he 
had  practiced  masturbation  to  a  very  limited  extent,  but 
had  not  done  so  for  fifteen  years  prior  hereto.  He  also 
admitted  that  he  had  attempted  intercourse  twice  only  and 
had  such  an  utter  failure,  and  was  so  disgusted  with  him- 
self, that  he  had  never  had  sufhcient  confidence  to  make 
a  third  effort.  He  had  noticed  a  milky  discharge  at  times 
just  preceding  the  passage  of  urine,  and  also  when  at  stool, 
especially  if  costive. 

Further  examination  of  the  gland  showed  it  to  be  ex- 
cessively sensitive  both  through  the  prostatic  urethra  and 
rectum.  A  bougie  was  introduced  every  third  day  into 
the  bladder,  and  a  suppository  composed  of  five  grains 
each  of  boric  acid  and  aristol  introduced  into  the  rectum 
at  night.  At  the  end  of  the  third  week  urethral  catapho- 
resis  was  instituted.  The  treatment  was  similar  to  that 
given  in  the  former  cases,  except  that  only  cataphoresis 
was  used  and  only  once  a  week.  Complete  recovery  fol- 
lowed after  four  months'  treatment. 

Case  IV. — Prostatitis,  Epilepsy. 

Married;  aged  twenty-eight,  thin,  nervous,  wild  eyed 
and  as  restless  a  man  as  I  think  I  ever  saw.  He  was  born 
and  raised  in  the  country  by  an  intelligent,  well-to-do 
widow.  At  about  fourteen  he  began  masturbating,  and  at 
sixteen  had  epileptic  fits.  They  assumed  a  periodicity  and 
at  first  recurred  about  every  four  weeks,  then  every  two 
weeks,  often  followed  by  two  or  three  attacks  in  one  or  the 


70  PROSTATE  GLAND  AND  ADNBXA. 

succeeding  day.  They  continued  to  grow  more  frequent 
and  severe  until  he  would  have  two  or  three  attacks  a  week. 
He  was  at  first  treated  by  his  lodal  physician  with  bro- 
mides, which  controlled  them  to  some  extent  in  frequency 
and  severity,  but  at  the  expense  of  his  physical  and  ner- 
vous system.  He  went  the  round  of  neurologists  in  N"ew 
York,  Cincinnati  and  St.  Louis  for  ten  years.  The  last 
physician,  after  having  had  him  under  treatment  for  more 
than  a  year,  trephined  him,  as  he  said,  for  too  much  blood 
upon  the  brain.  Still  there  was  but  little  temporary  re- 
lief. He  had  taken  bromides  until  he  was  almost  an  im- 
becile, when  he  returned  home.  His  local  physician  ad- 
vised him  to  get  married,  which  he  did  about  nine  months 
before  coming  under  my  care. 

The  objective  symptoms,  as  determined  by  an  examina- 
tion, revealed  phimosis  in  a  marked  degree,  the  glans 
penis  and  meatus  being  red  and  very  sensitive.  The  ure- 
thra was  so  extremely  hyperesthetic  that  an  attempt  at 
introducing  a  bougie  almost  threw  him  into  convulsions. 
My  first  step  in  the  way  of  treatment  was  to  circumcise 
him,  then  by  the  use  of  injections  of  argyrol,  to  allay 
the  supersensitiveness  until  I  was  enabled  to  make  an  ex- 
amination of  the  prostate,  which  was  quite  irritable  and 
sensitive.  On  account  of  the  extreme  tenderness  of  the 
urethra  and  prostate  I  passed  a  bougie  only  once  a  week, 
continuing  the  injection  at  the  same  time.  The  bromides 
were  also  continued,  but  in  smaller  doses.  He  had  been 
taking  the  bromide  of  ammonium  in  scruple  doses  three 
times  daily.  I  gave  him  bromide  of  sodium  in  ten  grain 
do_ses  three  times  daily,  gradually  diminishing  to  eight, 
five,  then  five  twice  a  day.  The  epileptic  attacks  became 
less  frequent  and  severe  until  they  again  assumed  periodic- 
ity, returning  every  twenty-eight  days.  I  had  him  discon- 
tinue the  use  of  the  bougie  and  began  that  of  cataphoresis 


SUBACUTE  OR  CHRONIC  PROSIATITIS.  71 

with  mild  solution  of  argyrol.  Patient  was  under  treat- 
ment fourteen  months.  For  five  months  before  he  was- 
dismissed  he  had  not  had  an  epileptic  attack,  nor  had 
he  taken  a  dose  of  bromide  for  three  months.  Eleven 
and  one-half  months  from  the  time  he  began  treatment 
his  wife  was  delivered  of  a  girl  baby.  The  patient  became 
quite  strong  and  corpulent,  returned  to  his  mother's  farm, 
and  I  have  not  heard  from  him  since. 

Quite  a  number  of  cases  similar  to  the  last  two  have 
come  under  my  observation.  They  were  traceable  to  dis- 
ease of  the  prostate  and  exhibited  a  variety  of  neurotic 
disturbances  as  a  result  of  masturbation,  continence,  or 
excessive  sexual  indulgence. 

In  the  treatment  of  this  class  of  diseases,  when  I  sus- 
pect the  lurking  of  gonococci,  and  that  the  prostatitis  is 
due  to  the  toxins  secreted  by  these  germs,  I  use  ichthyol 
or  other  germicidal  agents  by  means  of  cataphoresis,  after 
having  allayed  all  acute  symptoms  by  the  process  before 
described.  In  those  not  due  to  gonorrheal  infection,  I 
prefer  aqueous  extract  of  verbascum,  thuja,  echinacea,  or 
a  combination  of  two  per  cent  solution  of  equal  parts  of 
the  latter  two,  and  used  in  the  same  way. 

Case    V. — Prostatitis,    Vesiculitis,    Prostatic    Ure- 
thritis. 

Single ;  aged  thirty-three.  The  only  subjective  symptom 
of  which  this  man  complained  was  total  impotency.  Other- 
wise he  was  in  fairly  good  health,  and  attended  his  busi- 
ness daily.  He  had  never  indulged  in  alcoholic  drinking. 
He  had  masturbated  some  in  early  youth,  but  abandoned 
it  quite  soon  for  sexual  indulgence,  which  he  carried  to 
great  excess.  This  inordinate  indulgence  was  maintained 
for  five  or  six  years,  when  an  impairment  of  function  was 
noticeable.     This  condition  continued  to  grow  worse,  until 


73  PROSTATE  GLAND  AND  ADNEXA. 

a  physician  was  consulted^  who  prescribed  aphrodisiacs. 
Temporary  excitement  followed  the  use  of  the  drugs, 
which  was  soon  followed  by  complete  collapse.  Other 
drugs  were  tried  without  avail.  The  physician  endeavored 
to  persuade  him,  as  he  had  no  apparent  physical  ailment, 
that  "it  was  all  in  his  head."  He  never  had  gonorrhea,  or 
any  kind  of  venereal  disease.  A  second,  third  an'd  fourth 
physician  was  consulted;  each  of  whom  treated  him  simi- 
larly to  the  first  without  the  least  benefit.  Neither  of  the 
doctors  made  a  physical  examination,  as  they  took  it  for 
granted,  that,  as  he  had  never  had  gonorrhea,  there  was  no 
lesion  of  the  genital  organs  causing  the  trouble.  This 
treatment  extended  over  a  period  of  six  years,  and,  strange 
to  state,  no  quack  remedies  were  taken  in  all  this  time. 

Upon  passing  a  bougie  a  houle,  I  noticed  very  little  sen- 
sitiveness until  the  prostatic  portion  of  the  urethra  was 
reached.  Examination  with  the  cystoscope  revealed  an  in- 
flamed and  granular  surface  along  the  floor  of  the  pros- 
tatic urethra.  The  other  portion  of  the  canal  was  normal. 
The  prostate  and  vesicles  were  slightly  tender  upon  pres- 
sure. As  revealed  through  the  proctoscope  the  rectal  mu- 
cosa opposite  the  gland  and  vesicles  was  red  and  somewhat 
inflamed,  but  not  abraded. 

On  the  second  day,  after  the  examination,  ISTo.  14  A. 
bougie  was  passed  annointed  with  benzoinol  ointment.  It 
entered  the  bladder  quite  easily,  and  with  very  little  irri- 
tation. Two  days  thereafter  cathodal  electrolysis,  with 
No.  VIII  electrode  14  A.,  using  ten  per  cent  strength  of 
argyrol,  was  introduced.  This  application  was  attended 
with  a  current  strength  of  ten  m.a.,  and  of  five  minutes 
duration.  Two  days  afterwards  a  sinusoidal  treatment  of 
the  prostate  and  vesicles  through  the  rectum  was  given. 
Applications  were  given  alternately  through  the  rectum 
and  urethra  for  ten  weeks.     The  nocturnal  emissions  oc- 


SUBACUTE  OR  CHRONIC  PROSTATITIS.  73 

curred  only  about  once  every  three  or  four  weeks.  At 
times  he  would  pass  six  weeks  without  an  emission,  which 
I  did  not  consider  abnormal,  nor  did  they  depress  him. 
This  proved  to  be  one  of  the  most  obstinate  cases  I  ever 
treated,  which  was  due  evidently  to  the  long  continued 
use  of  aphrodisiacs. 

Case  VI. — ^Prostatitis,  Vesiculitis  and  Urethritis. 

Single;  aged  twenty-seven;  gonorrheal  origin.  This 
young  man.  had  gone  the  rounds  of  first  the  druggists,  then 
the  quacks.  He  was  suffering  intensely  from  dysuria,  pain 
in  the  back,  perineum  and  left  groin.  There  was  a  gleety 
discharge,  which,  at  times,  was  profuse,  then  again,  very 
scant.  It  was  his  first  attack,  and  it  had  been  running  for 
eighteen  months. 

His  treatment  had  consisted  of  injections,  systemic  med- 
ication, irrigations  and  sounds.  The  meatus  was  very 
much  contracted,  and  the  urethra  was  tender  throughout 
its  entire  course.  There  were  localized  patches  along  the 
canal  much  more  sensitive  than  at  other  points.  The  rec- 
tum was  quite  tender  and  often  protruded  while  straining 
to  void  urine  when  at  stool.  The  parts  were  so  tender  that 
I  did  not  attempt  a  thorough  examination  at  first.  I  had 
him  inject  a  ten  per  cent  solution  of  aqueous  extract  of 
argyrol  five  times  daily.  He  was  also  instructed  to  in- 
troduce a  suppository  of  boric  acid,  ten  grains,  and  extract 
of  belladonna,  three-quarters  of  a  grain,  night  and  morn- 
ing. After  three  days  the  acute  symptoms  had  greatly 
subsided,  when  the  benzoinol  ointment  was  begun.  Exami- 
nation was  made  at  the  end  of  a  week,  disclosing  three 
granular  patches  in  the  urethra ;  the  first  at  one  inch  back 
of  the  meatus,  the  second  at  six  inches  and  the  last  in  the 
prostatic  portion.  The  rectum  was  inflamed  and  abraded 
opposite  the  prostate  and  very  red  and  tender  high  up  and 
about  the  vesicles. 


74  PROSTATE  GLAND  AND  ADNEXA. 

The  treatment  was  similar  to  that  before  described,  ex- 
cept that  ichthyol  was  used  in  cataphoresis,  it  being  a  more 
decided  germicidal  agent.  The  injection  was  continued 
during  the  first  month's  treatment  to  control  the  urethritis. 
Eecovery  followed  three  months'  treatment. 

There  are  many  similar  cases  to  these  with  various  com- 
plications. At  times  the  bladder  is  involved  but  it  very 
rarely  requires  special  treatment.  It  readily  recovers  as 
soon  as  the  other  troubles  are  relieved.  It  is  exceedingly 
rare  that  the  gonococci  invade  this  viscus;  and  especially 
with  young  men  whose  urine  is  almost  invariably  aseptic 
and  noxious  to  these  germs. 

Occasionally  I  find  some  cases  where  ulceration  upon 
the  floor  of  the  prostatic -urethra  resists  the  methods  of 
treatment  before  detailed.  In  such  cases  I  bring  the  ulcer 
into  view  by  means  of  the  cystoscope,  which  I  prefer  for 
this  part  of  the  canal  to  the  urethrascope,  and  touch  it 
with  twenty  per  cent  of  ichtbalgon  or  fifty  per  cent  of 
argyrol. 

Where  the  prostate  or  vesicles  are  very  tender,  I  often 
suspend  urethral  treatment  for  some  days,  and  apply 
through  the  rectum  to  these  organs  the  secondary  faradic 
current  with  from  fifteen  to  twenty  thousand  ohms  re- 
sistance. This  treatment  acts  as  an  analgesic  and  allays 
local  irritation. 


CHAPTEK  IV. 

CHEONIC  CONGESTED  ENLARGEMENT  OF  THE  PROSTATE. 

This  affection  of  the  gland  is  common  in  middle  age, 
and  occurs  more  frequently  between  the  ages  of  forty  and 
sixty.  It  is,  however,  not  infrequent  as  early  in  life  as 
thirty-five  and  even  past  seventy  without  the  existence  of 
senile  or  fibrinous  hypertrophy.  I  have  had  three  cases — 
one  seventy-two,  another  one  year  older  and  a  third  sev- 
enty-nine— with  congested  enlargement,  and  inflammation 
of  the  gland,  seminal  vesicles  and  neck  of  the  bladder, 
without  fibrinous  induration. 

The  idea,  so  generally  prevalent  among  the  profession, 
that,  when  a  man  past  forty  or  fifty  has  any  disease  of  the 
prostate,  it  is  indurated  hypertrophy  and  incurable,  is  er- 
roneous. This  disease  of  the  gland  is  one  of  passive  ve- 
nous congestion,  soft  submucous  infiltration  and  a  swollen 
enlargement  of  the  organ,  which  generally  results  in  in- 
flammation not  only  of  the  gland  itself,  but  of  most  all 
the  other  pelvic  viscera.  It  is  somewhat  analogous  to  the 
congested  and  inflamed  condition  of  the  uterus  and  its 
appendages.  Not  every  woman  that  has  venous  stasis  and 
an  inflamed  womb  has  fil^roid  tumors  developed  within  its 
wails.  In  fact,  the  latter  is  rare  as  compared  with  the 
number  of  cases  of  the  former.  In  like  manner  fibrinous 
tumors,  or  hypertrophy  of  the  prostate,  is  rare  as  compared 
with  the  numerous  occurrences  of  congested  enlargement. 
•  I  have  treated  quite  a  number  of  cases  of  this  class  of 
prostatitis,  that  had  been  treated  by  different  physicians 
for  many  years,  and  pronounced  hypertrophy  and  incura- 
ble. Some  of  these  cases  had  not  only  been  treated  by  the 
family  physicians,  but  by  many  of  the  leading  specialists 
in  this  line. 

75 


76 


PROSTATE  GLAND  AND  ADNEXA. 


Fig.  XII. 


ENLARGEMENT   OF   THE  PROSTATE.  77 

It  is  somewhat  difficult  in  some  cases  to  diflEerentiate  at 
first  between  congested  enlargement  and  fibrinous  indu- 
rated hypertroph5^  The  diagnosis  will  be  considered  more 
at  length  under  the  head  of  diagnosis  that  will  follow  upon 
this  subject.  I  shall  add  here,  however,  that,  basing  a 
statement  upon  my  own  clinical  experience,  at  least  twenty 
cases  of  congested  enlargement  of  the  gland  occur  to  one 
of  hypertrophy.  I  do  not  include  in  this  estimate  chronic 
prostatic  folliculitis  common  to  young  men. 

Cause. — The  most  potent  etiological  factors,  productive 
of  this  form  of  disease  of  the  prostate,  are  common  with 
those  that  excite  chronic  inflammation  of  the  gland  as  de- 
tailed in  Chapter  III.  When  folliculitis  is  not  arrested  and 
it  is  permitted  to  extend  and  induce  parechymatous  pros- 
tatitis and  plastic  exudation,  interstitial  infiltration  is  the 
natural  sequence.  The  exudate,  thus  produced,  extends  to 
the  muscular  fibers,  and  its  pressure  upon  the  blood  and 
lymph  vessels  increases  stasis,  and  chronic  enlargement 
and  infiammation  of  the  entire  gland  results. 

Inordinate  indulgence  in  alcoholic  liquors,  whether  char- 
acterized by  excessive  bouts  of  drinking  or  a  moderate 
though  constant  habituate,  excites  and  increases  congestion 
of  the  gland;  and,  where  any  previous  lesion  of  any  part 
of  the  genito-urinary  tract  exists,  it  is  aggravated.  Es- 
pecially is  this  fact  more  apparent  when  beer  or  fermented 
wine  is  employed. 

Since  it  has  become  a  proven  fact  that,  in  from  seventy- 
five  to  eighty-five  per  cent  of  gonorrheal  cases,  the  cocci 
invade  the  gland,  and  there  remain  dormant  indefinitely, 
producing  poisons  that  maintain  a  slow  though  constant 
irritation,  besides  that  engendered  by  the  germs  them- 
selves and  the  debris  of  their  cadavers,  chronic  inflamma- 
tory enlargement  of  the  gland  should  receive  more  prompt 
attention  than  is  generallv  accredited  it.    One  reason  that 


78  PROSTATE  GLAND  AND  ADNEXA. 

it  fails  to  arouse  the  uneasiness  its  importance  demands 
is  because  of  the  insidious  manner  of  the  progress  of  the 
disease,  and  of  the  variable  character  of  the  subjective 
symptoms.  At  times  all  symptoms  may  be  entirely  lacking, 
or  they  may  recur  in  a  somewhat  aggravated  form  necessi- 
tating the  consulting  of  the  family  physician,  who  may 
not  give  it  the  significant  attention  requisite,  and  usually 
dismiss  the  case,  without  examination,  by  prescribing  a 
diuretic,  and  permit  the  development  of  the  gland  until  it 
becomes  quite  serious. 

Any  form  of  dissipation  aggravates  the  trouble;  but 
it  has  been  particularly  noticeable  with  that  class  of  men 
who  have  at  some  time  of  life  been  addicted  to  alcoholism 
and  its  companion  in  crime,  excessive  venery. 

Lesion  of  the  gland,  whether  of  gonorrheal  origin  or 
due  to  other  causes,  is  more  easily  excited  by  stimulants, 
at  least  for  a  time,  until  a  complete  breakdown  follows. 
In  other  instances  the  irritation  arising  from  lesion  of  the 
gland,  whether  due  to  dissipation  or  other  causes,  creates 
an  insatiable  sexual  desire,  that  affects  the  central  nervous 
system  to  such  an  extent  as  to  cause  mental  disturbances 
of  various  kinds.  Such  persons  are  often  too  modest  to 
reveal  all  the  facts  to  their  family  physician,  and  fre- 
quently endeavor  to  deceive  even  the  specialist  whom  they 
may  consult.  It  is  much  better,  in  such  cases,  for  total 
impotency  to  supervene  than  to  provoke  an  immoderate 
drain  upon  the  nervous  system,  by  excessive  sexual  con- 
gress, which  often  results  in  paresis,  impaired  memory  or 
even  insanity.  It  was  no  doubt  due  to  this  fact  that  only 
a  few  years  ago  castration  was  advocated,  and  performed 
quite  frequently  for  insanity.  It  was  claimed  that  marked 
relief  followed  the  operation  in  some  cases,  while  others 
were  reported  as  cured. 

Ulceration  of  the  rectum,  whether  result  in  ^^  from  uros- 


ENLARGEMENT   OF   THE  PROSTATE.  79 

tatitis,  IS  usually  concomitant  therewith,  or,  originating 
from  other  causes,  evidently  provokes  and  maintains  pros- 
tatic congestion  and  inflammation,  on  account  of  its  being 
in  such  close  proximity  to  the  gland. 

Horseback  riding,  and  especially  those  who  do  very 
much  of  it,  aggravates  an  existing  prostatitis,  even  though 
it  may  not  be  the  prime  cause  of  it.  I  have  found  this 
trouble  quite  prevalent  among  country  physicians,  who  are 
compelled  to  visit  their  patients  on  a  horse.  Bicycle  rid- 
ing has  equally  as  bad,  if  not  worse,  effect  upon  the  gland. 
■I  do  not  think  moderate  riding  either  upon  a  horse  or 
wheel  has  any  injurious  effect  upon  the  prostate,  when  it 
is  in  a  healthy  condition,  and  the  rectum  is  free  from  ulcera- 
tion. In  fact,  the  irritation  is  transmitted  to  the  gland  by 
the  saddle  through  the  rectum  and  lower  urethra. 

Cold  often  excites  congestion  of  the  prostate,  and,  when 
prolonged  or  habitually  exposed,  it  especially  aggravates 
an  already  inflamed  gland.  Violent  and  long  continued 
use  of  instruments  are  potent  causes  of  enlargement  of 
the  organ,  and  especially  when  large  sounds  are  employed, 
pressing  upon  the  inflamed  gland.  The  practice  is  a  com- 
mon one  and  is  generally  advised  by  surgeons ;  and,  in  fact, 
is  almost  universally  used.  Unless  the  sound  is  handled 
by  a  skilled  operator  the  end  of  it  strikes  the  gland  in 
such  way  as  to  do  much  harm. 

Strong  injections  and  cautery  applications  to  the  pros- 
tatic urethra  often  produce  serious  trouble.  The  admin- 
istration of  aphrodisiacs  for  impotency,  which  is  a  common 
symptom  of  this  disease,  has  a  pernicious  effect  upon  the 
gland.  The  exciting  by  these  medicines,  of  a  diseased 
gland,  incapacitated  for  its  normal  function,  to  produce 
an  abnormal  congestion  and  orgasm,  often  provokes  serious 
trouble.  It  is  a  very  general  practice  of  giving  these  reme- 
dies in  a  blind  manner,  without  having  examined  the  pros- 


80  PROSTATE  GLAND  AND  ADNEXA. 

tate  with  the  view  of  discovering  the  real  cause  of  the 
trouble. 

SYMPTOMS. 

The  symptoms  are  somewhat  common  to  those  of  chronic 
prostatitis  of  young  men,  except  that,  in  this  form  of 
disease,  there  are  more  complications,  and,  in  some  cases, 
a  higher  degree  of  inflammation,  as  a  result  of  the  large 
size  of  the  gland  impeding  the  free  flow  of  urine.  Often 
vegetative  growths  spring  up  in  the  prostatic  urethra,  and 
around  the  vesicle  neck,  which  at  times  project  into  the 
anterior  part  of  the  bladder.  These  may  develop  into 
polypoid  tumors,  that  flop  about  the  neck  of  the  bladder 
like  a  valve,  and  shut  off  the  flow  of  urine,  for  a  time. 
These  tumors  are  very  vascular  and  inclined  to  periodical 
hemorrhages. 

Prostatorrhea  may  be  constant  or  periodical,  and  is 
often  mistaken  for  spermatorrhea.  The  former  may  be  so 
slight  as  to  appear  only  in  the  form  of  gleet ;  or  it  may  pre- 
cede the  flow  of  urine,  when  it  has  accumulated  within 
the  prostatic  urethra,  in  the  form  of  a  milky  fluid.  Others 
have  the  white  discharge  just  at  the  cessation  of  the  pas- 
sage of  the  urine.  When  the  latter  occurs  the  discharge 
accumulates  within  the  prostatic  ducts;  and  by  spasm  of 
the  prostatic  sphincter  in  expelling  the  tardy  urine,  ejects 
also  this  secretion.  In  other  cases,  and  especially  when 
vesiculitis  coexists,  spermatic  fluid  may  also  pass.  These 
fluids  are  usually  mixed  with  pus  and  mucus. 

The  urine  in  these  cases  is  almost  invariably  abnormal. 
Its  changed  condition  depends  mostly  upon  the  extent  of 
lesion,  the  size  of  the  gland,  the  length  of  standing,  and 
the  bladder  complications.  The  vesicle  neck  is  the  first 
part  of  that  viscus  to  become  involved,  and,  in  most  cases, 
it  does  not  extend  further,  unless  of  very  long  standing. 
The  urine  generally  changes  from  its  normal  acid  reaction 


ENLARGEMENT   OF   THE  PROSTATE.  8] 

and  aseptic  condition  to  that  of  alkaline^  and  is  no  longer 
innoxious  to  bacteria,  but  favors  their  development.  The 
action  of  bacteria  upon  exfoliated  mucus  favors  pyogene- 
sis  and  the  production  of  ammoniacal  urine.  The  latter  is 
exceeding^  irritating  to  the  bladder  and  especially  at  the 
neck,  causing  frequent  and  painful  urination.  This  is 
particularly  noticeable  during  the  day,  when  standing  or 
walking,  as  the  urine  gravitates  to  the  neck  or  tender  part 
of  the  bladder  or  prostate.  The  prostatic  urethra,  being, 
as  a  rule,  the  most  sensitive  part  of  the  genito-urinary 
tract,  is  often  rendered  spasmodic  by  the  acrid  urine,  and 
the  unpleasant  sensation  of  still  more  to  be  voided  even 
after  the  evacuation  of  the  bladder;  or  it  may  cut  off  the 
flow  for  a  few  moments,  when  it  again  relaxes,  and  allows 
the  passage  of  a  small  quantity  of  the  urine.  The  irrita- 
tion of  the  gland  or  bladder  is  frequently  reflected  to  the 
kidneys,  causing  polyuria,  that  is  mistaken  by  many  for 
diabetes  or  Bright's  disease.  This  condition  may  last  a 
long  time  without  effecting  any  organic  disease  of  the  kid- 
neys. 

Systemic  disturbances  are  quite  common,  either  as  a  re- 
sult of  metastasis,  or  as  a  direct  sequel  of  the  diseased 
gland.  Toxins  or  ptomaines  emanating  from  the  latent 
gonococci,  and  carried  by  the  blood  currents  to  the  joints, 
nerves  and  serous  membranes,  induce  metastatic  rheuma- 
tism, neuralgia,  peritonitis,  perityphilitis  or  various  other 
troubles  from  the  back  of  the  neck  to  a  pain  in  the  heel. 

As  a  direct  or  reflect  neurotic  disturbance,  arising  from 
disease  of  the  gland,  tlie  sciatic  nerve,  or  some  of  iti 
branches,  is  the  most  frequently  affected.  Pain  over  the 
hip  or  in  the  calf  of  the  leg  is  common.  This  may  also  ex- 
tend to  the  back,  and  become  so  serious  as  to  impair  the 
use  of  one  or  both  legs. 

There  is  often  tenderness  in  the  region  of  the  perineum. 


82  PROSTATE  GLAND  AND  ADNEXA. 

or  a  dull  heavy  aching  sensation,  which  is  felt  while  stand- 
ing or  sitting.  I  have  known  some  who  could  not  ride  in 
a  buggy  with  any  degree  of  comfort;  others  who  were  ne- 
cessitated to  carry  rubber  cushions,  hollowed  out  in  the 
center,  around  with  them. 

The  objective  symptoms  revealed  by  examination  through 
the  rectum  is  an  enlargement  of  the  gland,  which  gener- 
ally protrudes  as  an  oval  mass  upon  its  front  wall.  If  in- 
flammation of  the  gland  coexists,  there  is  either  redness  or 
lesion  of  the  mucous  lining  of  the  bowels  at  that  point. 
Upon  examination  with  the  sigmoidoscope  (Fig.  VII),  the 
same  condition  of  the  membrane  may  be  noted  higher  up, 
opposite  the  seminal  vesicles,  together  with  an  inflamma- 
tory complication  of  the  latter. 

Pressure  upon  the  gland,  through  the  rectum,  deter- 
mines the  extent  of  the  inflammatory  state  which  is  usually 
reflected  to  the  glans  penis  or  perineum.  It  requires  an 
experienced  touch  of  the  finger  to  determine  whether  this 
enlargement  is  due  to  a  swollen  condition  (the  result  of 
passive  venous  stasis  and  soft  infiltration)  or  to  indurated 
hypertrophy.  In  the  former,  both  lobes  of  the  prostate 
are  usually  about  equally  swollen  and  tender,  and,  while 
somewhat  firm  to  the  touch,  do  not  feel  cartilaginous.  The 
lobes  of  the  gland  appear  more  symmetrical,  and  are  not 
nodulated.  In  indurated  hypertrophy  the  portion  of  the 
gland  that  is  involved  is  quite  firm  and  in  most  cases  feels 
nodulated,  just  as  fibrous  tumors  as  developed  in  any 
other  organ  of  the  gland  (as  in  the  mammary)  might  re- 
veal themselves  to  the  touch.  This  subject  will  be  con- 
sidered more  fully  in  the  chapter  of  senile  hypertrophy  of 
the  prostate. 

COMPLICATIONS. 

The  neck  of  the  bladder  invariably  becomes  involved, 
and  is  generally  quite  sensitive  to  the  touch  of  an  instru- 


& 


ENLARGEMENT  OF  THE  PROSTATE.  83 

ment  or  to  the  effect  of  acrid  urine  coming  in  contact  with 
it.  The  inflammation  is  usually  confined  to  a  limited  area 
of  the  mucous  lining  of  the  bladder  immediately  adjacent 
to  the  neck  or  base  of  the  prostate,  as  illustrated  in  Plate 
II.  But  in  cases  of  long  standing,  attended  with  much 
congestion  and  inflammation  of  the  prostate,  the  trouble 
extends  and  may  involve  the  entire  mucous  lining  of  the 
bladder.  And  as  this  condition  of  the  bladder  is  the  result 
of  prostatitis,  the  latter  must  be  relieved  before  any  per- 
manent benefit  can  be  expected  in  treatment  of  the  former. 
In  fact,  I  have  found  that  in  the  large  majority  of  cases 
the  little  benefit  that  would  accrue  from  the  antiseptic  so- 
lutions in  washing  the  bladder  is  more  than  counteracted 
by  the  ill  effects  of  passing  an  instrument  for  the  purpose, 
over  an  inflamed  prostate.  Besides,  when  the  bladder  is 
in  the  state  to  require  such  treatment,  the  urine  is  no 
longer  aseptic,  but  the  putrefaction  of  the  exfoliated  mu- 
cous favors  pyogenesis. 

Andrews  and  others  have  demonstrated  that  the  bacilli 
which  inhabit  only  that  portion  of  the  urethra  near  the 
meatus  and  in  the  fossa  navicularis,  are  constantly  present 
and  non-pathogenic  in  this  region,  but  become  pathogenic 
when  carried  by  instrumentation  to  the  bladder,  and  set 
up  a  muco-purulent  discharge,  when  the  condition  of  the 
urine  favors  such.  Andrews  further  states  that  the  use 
of  antiseptic  agents  sufficiently  strong  to  destroy  bacilli 
in  the  bladder  would  be  injurious  to  the  tissue  with  which 
they  come  in  contact.  I  have  noticed  in  a  great  many 
cases  where  muco-purulent  matter  existed  in  large  quan- 
tities in  the  urine,  that  the  amount  diminished  as  soon  as 
the  wash  was  discontinued  and  the  inflammation  of  the 
gland  was  reduced.  There  are,  however,  cases  in  which  the 
catheter  is  necessary  to  evacuate  the  bladder,  and  in  such 
instances  the  use  of  some  antiseptic  solution  in  irrigating 
it  is  of  great  value. 


84  PROSTATE  GLAND  AND  ADNEXA. 

The  urine  in  these  cases  is  usually  of  deep  straw  color, 
of  acid  reaction  and  high  specific  gravity.  Normally  it  is 
of  slight  acid  reaction,  greater  in  the  morning  when  first 
voided  after  being  retained  through  the  night,  less  so 
about  two  or  three  hours  after  breakfast,  when  it  may 
become  neutral  or  slightly  alkaline.  Should  it  retain  a 
strong  acid  reaction  throughout  the  day,  the  condition  is 
abnormal  and  irritating  to  any  chronic  or  acute  inflam.- 
matory  tissue  with  which  it  may  come  in  contact.  The 
abnormal  acidity  of  the  urine  in  these  diseases  is  due 
mostly  to  crystals  of  uric  acid,  which  usually  coexist  with 
those  of  calcium  oxylate.  Aside  from  their  chemic  action, 
these  fine  needle-like  crystals  are  mechanically  quite  irri- 
tating to  mucous  surfaces.  Epithelia,  mucus  and  pus  are 
nlso  present  in  proportions  varying  with  the  extent  of 
prostatocystic  involvement. 

In  other  cases  phosphatic  urine  predominates.  Here 
the  urine  is  over  alkaline  and  more  than  neutralizes  the 
normal  condition  of  acidity  or  even  the  excess  as  caused 
by  uric  acid.  It  is  exceedingly  acrid  in  its  local  effect, 
and,  in  connection  with  mucus  and  pus,  favors  the  devel- 
opment and  propagation  of  bacteria.  It  is  usually  of  light 
color  and,  upon  standing,  has  a  flocculent  mass  of  mucus 
and  pus  which  are  readily  deposited.  After  some  hours  it 
has  an  exceedingly  offensive  odor;  and,  if  urea  be  present 
in  large  quantity,  ammonia  is  given  off.  Urea  often  exists 
in  large  quantities  and  is  deposited  in  red  or  blood  like 
crystals  on  the  sides  and  bottom  of  the  vessels. 

While  these  abnormal  constituents  of  the  urine  are  irri- 
tating and  aggravate  prostato-cystitis,  yet  they  are  the  re- 
sult and  not  the  cause  of  prostatitis. 

With  alkaline  phosphatic  urine,  some  neurotic  compli- 
cation is  usually  concomitant,  especially  in  the  case  of  pa- 


ENLARGEMENT   OF   THE  PROSTATE.  85 

tients  who  notice  the  deposit  in  the  urine  and  associating 
it  with  Bright's  disease,  contemplate  an  early  demise. 

As  these  abnormal  conditions  of  the  urine  are  only  symp- 
toms, and  not  an  idiopathic  disease,  the  trouble  which 
gives  rise  to  them  must  be  relieved  before  any  permanent 
benefit  will  result.  It  is  necessary  however  to  remove,  as 
far  as  possible,  all  properties  of  the  urine  that  are  irri- 
tating to  the  prostate,  until  the  latter  can  be  restored  to 
its  normal  condition. 

Variations  of  the  urine  are  symptoms  of  much  import- 
ance in  this  disease,  and  should  be  given  more  than  passing 
observation  and  chemic  test.  The  epithelial  cells,  Bott- 
chers  crystals,  sympexia,  and  spermatozoa  as  revealed  by 
the  microscope,  are  symptomatic  of  special  lesions,  and  in- 
dicate the  complications  that  attend  disease  of  the  pros- 
tate. Thompson's  and  Goldenberg's  two  glass  test,  as  well 
as  Jadassohn's  three,  may  be  misleading  unless  subjected 
to  microscopical  examination.  The  first  part  of  the  urine 
passed  into  a  vessel  may  contain  a  large  quantity  of  float- 
ing shreds  or  glary  mucus,  and  the  latter  part  voided  into 
a  second  vessel  may  be  free  from  any  debris.  It  would  be 
evident  that  these  shreds  were  washed  from  the  urethra, 
but  it  is  by  no  means  proof  that  they  originated  there. 
Secretions  from  the  prostate  or  vesicles  escape  into  the 
urethra,  pass  along  that  canal  until  they  become  dried  and 
cling  to  its  walls.  Mucus  and  other  abnormal  secretions, 
being  of  sticky  material,  form  shreds  of  various  size  and 
fhape.  Treatment  confined  to  the  urethra  alone  would 
never  relieve  the  condition.  In  many  cases  treatment  of 
the  prostate  alone  would  clear  them  up,  while  in  others 
the  vesicles  too  require  treatment.  In  many  instances. 
where  the  bladder  is  affected,  a  large  quantity  of  mucus 
and  pus  appear  in  the  urine,  and  especially  when  the 
ffland  is  swollen  or  enlarged  so  as  to  interfere  with  the 


86  PROSTATE  GLAND  AND  ADNBXA. 

thorough  emptying  of  the  viscus.  Blood  may  also  be  pres- 
ent, either  escaping  from  the  prostate  or  urethra,  or  mixed 
with  the  urine.  Dark  colored  urine  indicates  its  presence, 
and  signifies,  in  the  majority  of  cases,  the  existence  of  a 
polypoid  or  vegetative  growth  protruding  from  the  pos- 
terior prostatic  wall. 

PROSTATIC    CALCULI. 

There  are  certain  concretions,  so  called- prostatic  calculi, 
that  form  in  the  prostatic  follicles  and  ducts  after  adult 
life.  Sir  Henry  Thompson,  who  has  described  them  fully, 
reports  that,  "of  one  hundred  prostates  examined,  these 
bodies  were  found  in  all  of  them."  In  younger  subjects 
they  are  very  small  and  can  be  detected  only  by  the  aid 
of  the  microscope,  while  in  older  prostates  they  can  be 
readily  seen  with  the  natural  eye.  They  are  entirely  dis- 
tinct from  renal  or  urinary  calculi,  which  begin  to  form 
either  in  some  part  of  the  kidney  or  bladder  and  continue 
to  develop,  by  accretion,  until  they  may  reach  considerable 
size.  The  concretions  of  the  prostate  are  usually  small 
and  rarely  develop  to  a  size  larger  than  a  pea.  Inflamma- 
tory conditions  of  the  gland,  preventing  the  normal  se- 
cretions, tend  toward  developing  these  bodies,  just  as  a 
catarrhal  condition  of  the  bladder,  and  cystitis,  produce 
urinary  calculi.  They  are  less  firm  than  the  latter,  and 
are  composed  mainly  of  calcium  and  sodium  phosphate, 
both  of  which  substances  are  electrolytes,  and  are  readily 
dissipated  by  interstitial  electrolysis. 

Owing  to  their  exceedingly  small  size,  they  very  rarely 
give  rise  to  trouble  in  young  men;  but  in  older  men  with 
swollen  inflamed  prostates,  they  act  as  foreign  bodies  press- 
ing upon  the  different  portions  of  the  sensitive  gland,  and 
give  rise  to  irritation,  which  is  manifested  by  frequent 
micturition,  vesical  tenesmus  and  pain  in  the  region  of  the 


ENLARGEMENT   OF   THE  PROSTATE.  87 

prostate,  perineum,  glans  penis  or  fossa  navicularis.  They 
are  usually  rough  upon  their  surface,  and,  when  they  de- 
velop to  the  size  of  a  pea,  often  give  rise  to  prostatic  ab- 
scess. 

Fig.  XIII.  shows  a  photo  engraving  of  specimens  of  these 
concretions,  that  were  passed  by  a  patient  sixty-one  years 
of  age,  with  an  exceedingly  tender  and  irritable  prostate, 
during  the  evening  following  a  treatment  by  cataphoresis. 
The  urine  was  passed  into  a  porcelain  vessel,  and  allowed 


Fig.    XIII. 

to  remain  over  night.  On  the  following  morning  it  was 
poured  off,  the  residue  adhering  to  the  vessel.  The  vessel 
was  then  rinsed  with  clear  water  and  the  residue  was 
scraped  from  the  bottom  of  the  vessel,  and  preserved.  It 
was  firmly  glued  together  by  a  muco-purulent  admixture, 
which  was  broken  apart  in  pieces  of  different  sizes,  as 
shown.  There  was  quite  a  large  quantity  of  these  pieces, 
making  in  all  about  a  drachm.  The  large  majority  of 
these  were  destro3^ed  by  experimenting  upon  them  with  the 
combined  properties  of  different  chemicals  and  electrolysis, 
in  order  to  determine  the  agents  that  would  be  most  active 
in  their  disintegration,  and,  at  the  same  time,  the  least  ir- 


88  PROSTATE  GLAND  AND  ADNEXA. 

ritating  to  the  gland.  The  remaining  pieces  were  pasted 
to  a  piece  of  dark  paper  and  a  photo  engraving,  or  "haU 
tone,"  made  from  it,  as  illustrated. 

These  experiments  were  carried  out  with  a  one  per  cent 
solution  of  chloride  of  sodium  and  water,  as  the  conduct- 
ing medium,  which  is  practically  the  same  as  that  of  the 
prostatic  urethra,  when  the  solution  is  applied  to  the  gland. 

The  experiments  were  first  made  with  non-oxidizable 
electrodes,  without  medical  agents,  first  the  anode,  then 
the  cathode  being  used  as  active  electrodes.  These  were 
made  with  mild  currents  of  long  duration,  then  strong  for 
a  short  period,  with  due  heed  to  the  electrolytic  changes  of 
the  conducting  medium,  and  the  presence  of  oxy-chloride 
at  the  anode  as  a  result.-  Oxidizable  electrodes,  of  various 
metals,  with  the  anode  as  active  pole,  were  next  tried.  I 
then  experimented  with  various  medicaments,  using  both 
oxidizable  and  non-oxidizable  electrodes,  affecting  thereby 
changes  upon  these  deposits  by  means  of  cataphoresis  and 
interstitial  electrolysis.  The  conclusions  at  which  I  ar- 
rived by  the  experiments  and  chemical  observance  were 
that  the  concretions  are  subject  to  electrolysis.  Cataphoric 
medicaments  are  only  required  to  reduce  any  inflammatory 
condition  of  the  gland  which  served  to  increase  the  cal- 
careous deposits. 

SYMPEXIA. 

In  addition  to  the  calcareous  formations  that  are  so 
generally  present  in  the  ducts  and  follicles  of  the  con- 
gested prostate,  there  exists  occasionally  a  lumpy,  gelatin- 
ous substance  of  a  whitish  or  light  red  color,  called  sym- 
pexia.  These  bodies  vary  in  size  from  that  of  a  small  pea 
to  twice  that  amount.  They  frequently  become  quite  firm 
and  provoke  much  local  irritation  of  the  gland  and  vesical 
neck,  causing  frequent  and  painful  micturition,  and  even 
abscesses  in  the  prostate,  when  thev  become  too  firm  and 


ENLARGEMENT   OF   THE  PROSTATE.  89 

large  to  pass  ofE  through  the  ducts.  They  have  also  been 
detected  in  the  seminal  vesicles,  where  doubtless  most  of 
them  begin  to  form  from  pent  up,  unhealthy  semen  and 
the  morbid  secretions  that  result  from  the  inflammatory 
condition  of  the  vesicles.  They  no  doubt  assume  their 
firmness  in  their  tardy  course  through  the  prostate,  where 
they  mingle  with  the  calcareous  matter  as  formed  in  the 
latter. 

They  do  not  pass  at  regular  intervals,  seldom  daily,  and 
usually  follow  the  emptying  of  the  bladder  or  the  dis- 
charge of  fecal  matter  while  at  stool.  I  have  noted  some 
cases  where  they  would  pass  once  or  twice  a  week,  then  not 
again  for  a  month.  Wben  they  pass  often,  they  are  of 
lighter  color  and  less  firm  than  those  that  have  been  pent 
up  in  the  gland  for  a  longer  time.  Their  mere  presence 
causes  great  annoyance  to  many  men  who  mistake  them 
for  semen.  They  may  occur  in  any  stage  of  prostatitis,  in 
young  men  as  well  as  older.  I  have  noted  them  more  fre- 
quently in  young  men,  leading  a  life  of  continence,  or  in 
middle  aged  men  of  long  standing  prostatitis. 

THE  LIVER. 

Just  what  relation  the  liver  bears  toward  the  prostate  I 
am  unable  to  state,  but  in  common  with  other  investigators, 
1  have  noticed  that  there  is  a  functional  disturbance  of 
ilie  former  following  disease  of  the  latter.  The  liver  per- 
forms the  important  role  of  being  the  chief  organ  in  con- 
verting the  insoluble  uric  acid  into  soluble  urea;  and, 
whenever  there  is  a  disease  of  the  prostate,  crystals  of  uric 
acid,  often  in  large  quantities,  make  their  appearance  in 
the  urine.  It  is  claimed  by  some  that  this  arrest  of  the 
function  of  the  liver  is  due  to  nervous  reflexes  provoked 
by  disease  of  the  prostate. 


CHAPTEE  V. 

SEMINAL  VESICLES. 

The  seminal  vesicles  and  prostate,  owing  to  their  con- 
liguous  relations  and  allied  functions,  and  to  the  fact  that 
the  latter  is  tunneled  by  the  ducts  of  the  former,  are  in 
close  pathologic  relations.  As  the  swollen  prostate  must 
inevitably  encroach  by  pressure  upon  the  ejaculatory  ducts, 
limiting  thereby  their  elasticity  and  diminishing  their  cal- 
iber, increased  exertion  is  necessarily  required  to  expel  the 
semen  through  the  narrow  channels;  and,  should  these  or- 
gans be  inflamed  or  tender,  pain  would  follow  the  ejection 
of  semen  during  or  immediately  succeeding  sexual  inter- 
course. The  pain  is  usually  felt  in  the  region  of  the  perin- 
eum, lower  part  of  the  rectum,  or  along  the  course  of  the 
vas  deferens  in  one  or  both  sides  of  the  groin. 

RECTUM. 

With  the  exception  of  the  neck  of  the  bladder  and  sem- 
inal vesicles,  the  rectum  is  most  frequently  involved  as  a 
result  of  chronic  prostatitis.  The  part  most  often  affected 
is  the  front  surface  immediately  opposite  the  prostate. 
Inflammation  of  this  organ,  owing  to  its  close  proximity 
to  the  rectum,  readily  extends  to  the  latter.  The  plate 
shows  the  position  where  it  most  often  occurs.  If  the  in- 
flammation is  of  short  duration  and  the  gland  is  only 
slightly  affected,  the  rectum  at  this  point  will  show  a  con- 
dition of  redness,  with  only  a  limited  protrusion  of  the 
prostate,  and  without  abrasion  of  the  surface  of  the  mu- 
cous membrane.  In  cases  of  long  standing  prostatitis, 
where  there  is  considerable  protrusion  of  the  gland  into  the 

90 


SEMINAL  VESICLES.  91 

rectum,  there  is,  as  an  almost  invariable  result,  lesion  of 
the  mucous  surface,  and  this  being  constantly  irritated  by 
the  passage  of  fecal  matter,  in  turn  reacts  upon  the  pros- 
tate, serving  to  increase  the  irritation  and  inflammation 
of  the  latter. 


Fig.   XIV. 
KIDNEYS. 

The  kidneys  are  very  rarely  involved,  although  the  pain 
in  the  lumbar  region  of  the  spine,  together  with  the  turbid 
urine,  often  leads  one  to  suspect  such  disease. 

The  pain  felt  in  the  lumbar  region,  at  about  the  fourth 
or  fifth  vertebra,  has  no  connection  with  the  kidneys, 
though  it  is  usually  spoken  of  as  "pain  in  the  kidneys." 
This  pain  is  in  the  center  of  the  back  and  very  low  down, 
while  that  of  the  kidneys  is  much  higher,  on  each  side, 
and  beneath  the  borders  of  the  lower  ribs,  as  illustrated 
by  Fig.  XV. 


92  PROSTATE  GLAND  AND  ADNEXA. 

The  inflammation  occasionally  extends  from  the  pros- 
tate to  the  bladder,  thence  through  the  ureters  to  the 
pelvis  of  the  kidneys,  provoking  pyelitis,  and  even  inter- 
stitial nephritis. 

Some  twelve  years  ago  I  attended  a  case,  of  fifteen  years' 
standing,  suffering  with  stricture,  prostatitis,  cystitis  and 
nephritis.  The  trouble  extended  to  the  pelvis  of  the  left 
kidney,  and  subsequently  to  the  entire  organ.  Suppura- 
tion ensued,  which  was  followed  by  an  abscess  on  the  back 
over  the  left  kidney.  The  abscess  had  formed,  and  had 
been  evacuated  three  times  during  the  preceding  two 
years,  before  I  saw  the  patient.  He  had  suffered  constant 
pain  in  that  kidney,  and  was  in  very  bad  health.  The 
abscess  formed,  and  was  evacuated  only  once  during  the 
early  stage  of  my  treatment.  He  afterwards  became 
strong  and  healthy,  and  lived  eight  years.  I  never  saw 
him  during  his  last  illness.  His  death  was  reported  as 
due  to  nephritis,  though  no  autojosy  was  made. 

TBEATMENT. 

The  treatment  of  chronic  congested  enlargement  of  the 
prostate  gland  is  somewhat  similar  to  that  described  in 
the  former  chapter  on  prostatitis.  One  must  take  into 
consideration  the  age  and  health  of  the  patient,  the  degree 
of  discomfort  to  which  he  is  subject,  the  extent  of  com- 
plications, tenderness  or  inflammation  of  the  gland  itself, 
urethra  or  rectum,  and  the  urgency  or  necessity  for  the 
relief  of  any  conditions  from  impending  danger  to  life. 

There  are  only  two  ways  by  which  we  can  reach  the 
prostate  for  direct  treatment,  viz.,  through  the  urethra  or 
rectum;  and  as  these  organs  are  so  closely  related  to  the 
prostate,  both  by  contiguity  and  continuity  of  structure, 
and  are  in  such  close  sympathetic  relation  with  it,  they 
are  generally  pathologically     involved.     They    therefore 


SEMINAL  VESICLES. 


93 


Fig.    XV. 


94  PROSTATE  GLAND  AND  ADNBXA. 

require  treatment  in  order  that  tlie  prostate  may  be 
reached  without  causing  pain  or  inflammation  to  these 
channels,  for  the  inflammation  is  liable  to  extend  and  in- 
crease the  already  existing  trouble  of  the  gland.  So  my 
first  step  is  to  give  relief  to  all  symptoms  of  an  urgent  or 
dangerous  nature;  then  allay,  in  so  far  as  possible,  all 
inflammation  of  the  urethra  and  rectum,  by  rendering  the 
passage  of  urine  and  fecal  matter  over  these  tender,  and 
probably  abraded  surfaces,  as  non-irritating  as  possible. 

Diet. — In  ordinary  cases  I  rarely  restrict  my  patients 
in  their  diet,  except  in  regard  to  particularly  indigestible 
food,  such  as  cabbage,  pork,  cucumbers  and  the  like.  I 
do  prohibit  alcoholic  liquors  while  the  patient  is  under 
treatment,  and  especially  fermented  ale,  beer  or  wine,  as 
they  directly  tend  to  disturb  the  circulation,  liver  and 
kidneys,  causing  an  excessive  precipitation  of  uric  acid, 
and  biliary  discharges,  and  increasing  local  irritation  to 
the  urinary  and  rectal  passages,  and  in  particular  to  the 
prostatic  urethra,  and  neck  of  the  bladder. 

I  have  mentioned  in  a  former  chapter  that  I  began  the 
radical  treatment  with  my  urethral  electrode  No.  1-1,  A, 
which  is  passed  down  the  urethra  gently,  after  having 
previously  made  the  electric  connections  before  described, 
and  with  three  to  five  milliamperes  in  the  circuit.  During 
the  first  treatment  the  application  should  not  last  over  one 
or  two  minutes,  and  the  electrode  should  be  passed  over 
the  entire  surface  with  the  current  in  the  circuit,  to  rid 
the  canal  of  whatever  granulations  might  exist  at  any 
point  in  its  course.  Cataphoresis  should  not  be  used  dur- 
ing the  first  treatments,  and  if  the  urethra  or  pjostate  is 
very  tender,  the  electric  treatment  should  not  be  given 
oftener  than  every  third,  fourth  or  even  seventh  day. 
Cathodal  applications  should  always  be  used  during  the 
first  few  times. 


SEMINAL,  VESICLES.  95 

As  a  rule  blood  will  not  be  produced  by  these  treatments, 
if  the  preliminary  steps  are  attended  to.  But  it  occasion- 
ally happens  that  some  highly  congested  granulations  or 
vegetative  growths  are  denuded  from  the  surface  of  the 
prostatic  urethra;  in  which  case  a  drop  or  two  of  blood 
may  follow.  No  harm  will  result,  but  the  operator  should 
be  warned  thereby  not  to  apply  the  electric  treatment  too 
often  or  with  too  great  strength.  I  usually  follow  up  such 
a  condition  with  an  injection  of  verbascum,  if  it  had  been 
discontinued;  then  two  days  afterwards  with  the  bougie, 
with  benzoinol,  or  an  ointment  of  the  extract  of  verbascum 
and  benzoinol,  which  is  quite  soothing.  At  other  times  I 
use  with  mild  electrolytic  applications  a  mixture  of  ben- 
zoinol and  verbascum  with  electrode  No.  VIII.  Cata- 
phoresis  is  only  slightly  effected  by  this  means,  as  osmosis 
of  oils  without  emulsification  does  not  take  place.  Only 
a  local  soothing  effect  is  produced,  but  the  oil  has  the 
additional  property  of  protecting  the  surface  for  a  time 
from  the  irritating  secretions  that  may  occur. 

It  is  also  essential  to  have  the  patient  void  urine  just 
prior  to  the  treatment,  then  to  remain  upon  his  back  for 
a  few  minutes  afterwards,  that  the  urine,  by  gravity,  may 
remain  away  from  the  vesical  neck,  or  prostate,  until  what- 
ever irritation  may  have  been  caused  by  treatment  has 
subsided.  All  of  these  points,  however  trifling  they  may 
appear,  require  careful  consideration  in  view  of  the  tender 
and  inflamed  condition  of  the  gland  and  adjacent  organs. 

After  the  acute  symptoms  have  subsided,  cataphoresis 
can  be  employed  with  impunity.  This  is  effected  in  two. 
ways,  first  by  means  of  liquid  medicines,  as  illustrated  by 
Fig.  X ;  secondly,  by ,  anodal  applications  of  oxidizable 
electrodes.  The  latter  is  accomplished  by  using  a  metal 
point  to  an  electrode  of  copper,  zinc  or  iron,  when  there 
will  form  the  oxy-chloride  of  copper,  zinc  or  iron.     Each 


96  PROSTATE  GLAND  AND  ADNBXA. 

of  these  excites  a  quite  sharp,  burning  sensation  and 
should  be  applied  only  directly  to  the  seat  of  the  trouble^ 
which  is  usually  on  the  floor  of  the  prostatic  urethra. 
These  new  substances  of  oxy-chlorides  of  copper,  zinc  or 
iron,  after  forming,  will  penetrate  the  gland  by  following 
the  direction  of  the  current,  from  positive  to  negative,  and 
cause  a  dull  aching  sensation  throughout  the  region  of  the 
prostate,  perineum  or  rectum.  They  should  be  given  only 
a  short  time  and  with  a  mild  current,  especially  during 
the  first  few  treatments.  The  electrode  will  adhere  to  the 
tissue,  and  should  not  be  removed  until  the  current  has 
been  reversed  for  one  or  two  minutes,  when  it  will  loosen. 

An  acute  discharge  often  follows  such  applications,  and 
the  patient  should  be  advised  of  the  fact,  or  he  may  sus- 
pect that  he  has  an  attack  of  gonorrhea  or  that  he  has  been 
infected  by  the  instrument.  Obstinate  chronic  cases  are 
much  benefited  by  this  method  of  treatment  and  yield  more 
readily  through  conversion  of  the  chronic  into  an  acute 
state  for  the  time.  Injections  of  ten  to  fifteen  per  cent  of 
verbascum  or  argyrol  readily  allays  the  acute  condition. 

Instruments  should  never  be  passed  into  the  urethra 
daily,  and  from  the  very  beginning  of  treatment  the  rec- 
tum should '  be  carefully  examined.  Should  it  be  very 
tender,  as  is  often  the  case  at  first,  suppositories  of  boric 
acid  and  aristol,  five  grains  each,  inserted  night  and 
morning,  will  soon  put  it  in  condition  for  examination  by 
speculum  or  sigmoidoscope  without  anesthetising  the 
patient.  I  alternate  the  treatment  by  giving  rectal  appli- 
cations, as  illustrated  by  Fig.  XI,  on  the  days  following 
the  urethral  treatment.  I  began  the  rectal  treatment  by 
using  the  secondary  faradic  current,  interposing  at  the 
time,  into  the  circuit  from  two  thous^d  to  twenty-five 
thousand  ohms  resistance.  This  treatment  is  very  sooth- 
ing, and,  in  most  cases,  affords  instant  relief   from  any 


SEMINAL  VESICLES.  97 

uncomfortable  feeling  that  may  exist  in  the  region  of  the 
perineum,  rectum  or  prostate.  Medicinal  applications  are 
made  to  the  rectum  at  the  same  time. 

While  the  oscillating  molecular  movements,  as  induced 
by  the  current,  favor  absorption  of  the  medicines,  yet 
eataphoresis  is  not  effected  thereby.  The  benefit  accruing 
from  the  secondary  faradic  current  is  chiefly,  if  not 
wholly,  that  of  its  mechanical  action;  and,  owing  to  the 
close  proximity  of  the  pole  to  the  gland,  as  shown  by  Fig. 
XI  (the  current  being  concentrated  and  flowing  only  in 
that  direction),  the  extremely  rapid  vibratory  motions 
exerted  upon  the  molecules  of  the  morbid  tissues  so  dis- 
turb them  as  to  cause  their  absorption  l^y  capillary  attrac- 
tion. This  may  be  illustrated  by  placing  medicine  of  any 
kind  upon  the  skin  of  any  part  of  the  body  and  rapidly 
rubbing  it,  absorption  takes  place  much  more  quickly  than 
if  the  medicine  remained  quiescent. 

Fig.  XVI  illustrates  the  application  of  a  longer  elec- 
trode to  the  seminal  vesicles.  Gentle  backward  pressure 
exerted  by  the  fingers  upon  the  lower  end  of  the  electrode 
causes  similar  movement  of  the  upper  end  upon  the  vesi- 
cles, and  produces  mild  contraction  of  the  latter.  This 
has  a  soothing  effect  upon  these  sacs,  and  at  the  same 
time  rids  them  of  their  morbid  contents,  reducing  the 
inflammation  of  the  organs,  and  that,  too,  without  pain. 
To  procure  the  best  results,  this  application  must  be  made 
with  ten  thousand  ohms  resistance  interposed. 

After  all  acute  tenderness  of  both  the  prostate  and  vesi- 
cles has  subsided,  I  apply  to  both  organs  the  sinusoidal 
current  in  the  same  way,  and  with  high  resistance  inter- 
posed, as  before  described.  This  current  as  explained  in 
Chapter  VIII  both  acts  mechanically  as  the  faradic,  and 
also  exerts  a  magnetic  influence  upon  the  atoms  of  the 
tissues,  causing  molecular  disturbance  by  the  attractive 


98  PROSTATE  GLAND  AND  ADNEXA. 

and  repulsive  power  of  unlike  and  like,  so  as  to  favor 
their  solubility  and  absorption,  and  their  expulsion  through 
the  medium  of  discharges  from  the  gland.  It  also  exerts 
a  strong  germicidal  effect. 


Fig.    XVI. 

Whatever  causes  the  pathological  condition  of  the  pros- 
tate— whether  it  is  the  inhabiting  of  its  mucosa  or  cellular 
tissue  by  latent  gonococci,  or  bacteria  adapted  to  the 
locality  of  its  special  epithelial  lining — it  is  certain  that 
diffusion  of  medicinal  agents  by  cataphoresis,  and  inter- 
stitial electrolysis  within  the  gland,  disturbs  these  germ? 
by   rendering   their   habitat   inimical   to    their   existence. 


SEMINAL.  VESICLES.  99 

Just  how  this  is  accomplished  it  is  somewhat  difficult  to 
explain;  but  bacteriologists  have  demonstrated  that  the 
gonococci  favor  an  alkaline  medium,  but  whether  the}^  are 
destroyed  by  cataphoric  diffusion  of  anions,  as  of  acids, 
oxygen,  etc.,  or  die  from  lack  of  a  suitable  medium,  when 
the  gland  is  aroused  to  activity,  or  the  dynamic  effect 
especially  of  the  sinusoidal,  or  -directly  as  the  result  of 
electrolysis  as  induced  by  cataphoresis,  I  cannot  state; 
but  I  do  know,  as  a  fact  demonstrated  by  numerous  re- 
sults of  such  treatment,  that  the  pathogenic  condition  is 
changed,  the  morbid  discharges  are  arrested,  and  the 
patient  is  restored  to  health.  To  know  the  precise  result 
of  such  treatments  is  more  gratifying  to  me  than  to  dis- 
course at  length  upon  some  far-fetched  scientific  theor)^ 

The  method  as  here  detailed  effects  all  that  can  be 
accomplished  by  digital  manipulation  of  the  prostate  or 
vesicles;  and,  too,  without  irritation,  I  often  have  com- 
plete emptying  of  the  vesicles  follow  rectal  treatment  by 
means  of  the  sinusoidal  application.  Infiltration  or  thick- 
ening of  the  rectal  mucosa  also  occurs  around  both  the 
prostate  and  vesicles,  when  the  disease  is  of  long  standing, 
which  is  readily  dissipated  by  this  treatment. 

Treatment  of  the  prostate  and  vesicles  through  the  rec- 
tum can  be  given  oftener,  stronger,  and  of  longer  duration 
than  through  the  urethra. 

MEDICINAL  TREATMENT. 

But  little  constitutional  medication  is  requisite.  In 
some  cases  where  acute  symptoms  exist,  it  is  necessary  to 
control  them  for  the  time  until  the  cause  is  removed.  An 
acid  condition  of  the  urine  serves  to  maintain  it  in  an 
antiseptic  condition,  unless  the  acidity  be  in  excess  of 
0.43  as  determined  by  acidemetry.  In  such  cases  citrate 
of  potassium,  or  some  lithia  water  or  salt,  gives  relief.     I 


100  PROSTATE  GLAND  AND  ADNEXA. 

concur  in  the  view,  as  expressed  by  Finger,  that  the  indis- 
criminate use  of  alkaline  mineral  waters  in  these  cases  is 
pernicious.  There  is  a  tendency,  after  passing  middle  age, 
to  the  accumulation  of  earthy  salts  in  the  body  (which  is 
conducive  to  senility,  and  the  constant  use  of  such  waters 
adds  to  the  evil).  Besides  changing  the  urine  from  its 
normal  acid  reaction  to  that  of  alkaline,  it  favors  the 
development  of  bacteria. 

When  the  urine  is  of  light  color,  and  alkaline  in  reac- 
tion, whether  due  to  excessive  phosphates  or  to  the  decom- 
position of  mucus  and  pus,  cystogen,  in  five-grain  doses, 
three  or  four  times  daily,  is  indicated.  When  it  is  admin- 
istered it  liberates  formaldehyde,  and  acts  by  controlling 
to  a  limited  extent  the  development  of  bacteria.  It  should 
not  be  continued  any  great  length  of  time,  as  it  becomes 
irritating  to  the  bladder  and  vesical  neck.  These  remedies 
are  only  intended  to  give  temporary  relief  until  the  cause 
is  removed,  which  is  the  relief  of  the  prostate  and  vesicular 
troubles. 

The  bladder  is  very  rarely  diseased  per  se,  but  is  almost 
invariably  the  result  of  the  extension  of  inflammation 
from  the  prostate  and  uretlira,  or  to  the  obstructive  flow 
of  urine  by  the  enlarged  gland. 

Diuretics  are  only  indicated  where  there  is  an  appear- 
ance of  symptoms  of  uremic  toxemia,  scantiness  of  urine 
or  an  excessive  quantity  of  urea. 

Many  suffering  from  long-standing  diseases  of  the  pros- 
tate become  anemic,  and  the  necessity  for  hemogenic  agents 
arises.  For  this  purpose  I  have  relied  upon  citrate  of  iron, 
which  is  less  irritating  to  the  stomach  than  most  of  the 
other  chalybeates. 

These  remedies  are  only  intended  as  valuable  adjuncts 
temporarily  until  radical  relief  of  the  gland  is  effected. 

Fig    XVII.  illustrates  an  electrode,  as  devised  by  the 


SEMINAL.  VESICLES. 


101 


author,  that  marks  a  new  era  in  the  treatment  of  varico- 
cele, orchitis  and  their  sequels,  impotency,  etc.  It  con- 
sists of  an  insulated  cup-shaped  receptacle,  near  the 
bottom  of  which  is  a  metallic  binding  post  for  the  attach- 
ment of  a  cord  from  a  battery.  On  the  inner  side  of  the 
cup  and  attached  to  the  binding  post  is  a  copper  plate, 


XVII 


which  serves  the  purpose  of  diffusing  the  current  through- 
out the  fluid  as  contained  within  the  cup.  When  in  use 
the  electrode  is  filled  to  about  four-fifths  with  plain  or 
medicated  water,  and  the  entire  scrotum  and  testicles  are 
immersed  therein.  That  portion  of  the  electrode  to  which 
the  cord  is  attached  is  placed  in  the  rear  and  pressed 
firmly  against  the  perineum  to  prevent  the  escape  of  the 
fluid.     A  large  sponge  electrode,  seven  or  eight  inches  in 


102  PROSTATE  GLAND  AND  ADNEXA. 

diameter,  is  placed  over  the  lumbar  region  of  the  spine. 
This  is  better  accomplished  by  the  patient  sitting  in  a 
chair  with  a  thick  book  at  the  back  so  as  to  press  the 
electrode  to  the  spine.  The  current  is  then  increased  to 
the  desired  strength,  care  being  observed  not  to  cause 
shock. 

The  current  thus  applied  charges  the  fluid  in  the  elec- 
trode, which  passes  up  through  the  spermatic  cords  and 
other  organs,  acting  as  a  tonic  to  the  muscular  and  dis- 
tended coats  of  the  veins,  causing  their  contraction,  there- 
by relieving  their  turgescence  and  tenderness,  and  giving 
tonicity  to  the  cords  and  scrotum,  which  enables  them  to 
support  the  testicles  and  maintain  them  in  their  normal 
position  without  the  aid  of  a  suspensory  bandage. 

Where  there  still  remains  impotency  or  depression  of 
the  genital  organs  after  relief  of  prostatitis,  the  current 
thus  used,  passing  through  the  genito-spinal  center  and 
the  genital  organs,  will  often  restore  their  normal  func- 
tions after  everything  else  fails. 

This  method  of  treatment  does  not  act  as  a  stimulant  or 
excitant  of  the  genital  organs,  as  do  some  medicines,  to 
be  followed  by  subsequent  depression,  but  serves  as  a  tonic 
and  restores  natural  vigor. 

Fig.  XYIIIa  illustrates  an  instrument  also  devised  by 
the  author  for  the  special  treatment  of  the  prostate  and 
vesicles  through  the  rectum.  The  upper  electrode  part  is 
insulated  about  two-thirds  and  is  screwed  to  the  vibrator. 
It  is  five  inches  in  length  and  when  inserted  may  be  passed 
up  so  as  to  come  in  apposition  to  the  entire  vesicles;  or 
withdrawn  and  concentrated  upon  the  prostate  alone.  The 
vibrations  can  be  regulated  from  3,000  to  10,000  per 
minute.  The  instrument  is  indispensable  in  the  treatment 
of  vesiculitis,  as  there  are  no  other  means  known  to  science 
that  will  reach  these  organs.     It  has  been  attempted  to 


Fig.  XVIIIa. 


PROSTATE  GLAND  AND  ADNEXA. 

treat  them  by  finger  massage,  but  it  is  well  known  to  any 
one  familiar  with  anatomy  and  the  position  of  these 
organs  that  the  fingers  are  too  short  to  reach  them.  Be- 
sides, it  is  patent  to  any  one  familiar  with  these  troubles 
that  simply  the  introduction  of  the  fingers  for  the  treat- 
ment of  the  prostate  and  vesicles  is  nothing  compared  in 
utility  with  the  high  vibratory  action  of  this  instrument. 
When  properly  used,  it  is  painless,  and  in  some  instances 
very  soothing.  Its  after-effects  are  very  marked.  The 
cases  where  the  instrument  is  specially  indicated  is  chronic 
vesiculitis,  chronic  inflammation  of  the  prostate  and  neck 
of  the  bladder,  impotency,  and  atony  of  all  these  organs. 
In  long  standing  inflammation  of  the  bladder,  prostate 
and  vesicles  they  lose  their  tone  and  become  partially 
IJaralyzed,  and  there  is  nothing  that  so  aroused  normal 
activity  as  the  use  of  this  instrument.  If  these  organs  are 
at  all  tender,  the  upper  end  of  the  instrument  must  be 
directed  back  from  the  vesicles  and  the  vibrations  made 
slowly.  These  can  be  increased  from  3,000  to  5,000  or  on 
up  to  10,000,  as  improvement  in  the  way  of  diminished  in- 
flammation progresses.  To  one  not  thoroughly  familiar 
with  the  electric  current  it  is  much  better  to  use  the  instru- 
ment alone,  but  there  are  many  cases  of  vesiculitis  where 
the  sinusoidal  current  used  in  connection  with  the  rapid 
vibrations  greatly  enhances  its  utility.  There  are  many 
cases  whereby  the  slightest  pressure,  not  enough  to  give 
pain  when  pressed  gently  against  the  vesicles,  completely 
empties  them  of  a  muco-purulent  discharge.  At  times, 
shreds  and  tube  casts  pass  off  in  the  discharge.  Why  I  state 

102b 


PROSTATE  GLAND  AND  ADNEXA. 

that  tlie  instrument  is  indispensable  in  tlie  treatment  of 
these  troubles  is^  that  I  had  never  been  able  to  thoroughly 
relieve  chronic  vesiculitis  and  impotenc}"  as  a  result  of  an 
impairment  of  the  functions  of  these  organs,  until  I  began 
the  use  of  this  instrument,  nor  have  I  kno"^vn  of  any  other 
means.  When  used  in  connection  with  either  the  sinu- 
soidal or  high  frequency  current,  it  destroys  any  gonoeocci 
or  other  micro-organisms  that  infest  the  vesicles.  Before 
I  began  the  use  of  this  instrument  in  the  treatment  of 
vesiculitis,  I  was  almost  at  sea,  but  now  I  undertake  their 
cure  with  as  much  confidence  as  that  of  any  other  organ. 
The  use  of  this  instrument  takes  the  place  of  finger 
massage  which  was  so  highly  lauded  a  few  years  ago,  and 
even  now  it  is  still  being  practiced  by  some  physicians. 
The  advantage  of  the  mechanical  massage  alone  is  one 
thousand  to  one  over  finger  massage,  and  with  the  con- 
joint use  of  the  sinusoidal  or  high  frequency  current  it  is 
two  thousand  to  one. 


Case  YII. — Peostatic  Enlargement  and  Melancho- 
lia, Obscure  Origin. 

Bachelor;  forty-eight  years  of  age;  weight  one  hun- 
dred and  seventy  pounds.  He  had  practiced  masturbation 
in  early  life  moderateh' — ^never  had  gonorrhea.  Always 
lived  in  a  small  town  and  had  been  successful  in  business. 
Up  to  his  forty-fifth  year  he  had  been  in  good  health. 
About  that  time  he  began  occasionally  to  pass  sleepless 
nights,  and  grew  gradually  worse.  This  continued  for 
about  one  and  one-half  3-ears,  when  he  became  melancholy 

102c 


SEMINAL.  VESICLES.  103 

and  despondent  about  his  business.  His  brother  had 
noticed,  at  times,  mental  aberration,  and,  after  consulting 
the  family  physician,  decided  upon  placing  him  in  a  sani- 
tarium. The  patient  tacitly  consented  to  go,  but  on  the 
evening  before  the  day  of  departure,  he  surreptitiously  left 
his  home,  and  wandered  about  from  place  to  place  for  more 
than  a  month,  when,  upon  incjuiring  for  a  physician,  he 
was  directed  to  me. 

He  was  very  secretive  as  to  his  family  and  home,  but 
talked  very  intelligently  and  freely  about  himself,  his 
wanderings,  habits  and  the  foolish  things  he  did  that 
induced  his  brother  to  think  he  was  verging  upon  lunacy, 
and  of  which  he  himself  was .  cognizant.  The  subjective 
symptoms  pointing  to  disease  of  the  gland  were  quite 
meager,  and  he  was  loth  to  submit  at  first  to  an  examin- 
ation. 

The  urethra  was  very  sensitive  throughout  its  length, 
and,  in  the  prostatic  part,  quite  painful  to  the  touch  of 
the  flexible  bougie.  The  gland  protruded  into  the  rectum 
to  the  extent  of  flattening  fecal  discharges.  Digital  pres- 
sure upon  the  jorostate  through  the  rectum  caused  an 
aching  pain  in  the  region  of  the  perineum  and  bladder. 

He  was  treated  alternate  days  with  a  flexible  bougie 
that  entered  the  bladder  easily.  The  faradic  current  was 
used,  each  intervening  day,  through  the  rectum  with  ten 
thousand  ohms  resistance.  The  inflammation  of  the  pros- 
tate and  urethra  readily  subsided  after  ten  days'  treat- 
ment, when  cataphoresis  to  the  prostate  was  instituted, 
both  through  the  urethra  and  rectum  with  ten  per  cent 
strength  of  acjueous  extract  of  verbascum.  His  recovery 
was  rapid,  and  at  the  end  of  the  first  month  he  was  sleep- 
ing normally,  and  his  mind  restored.  The  treatment  was 
continued  two  months  to  reduce  the  enlarged  gland.  Ee- 
covery  was  permanent. 


104  PROSTATE  GLAND  AND  ADNEXA. 

Case  VIII. — Prostatitis,  Vesiculitis.  Rectal  Ulcer- 
ation. 

Bachelor;  aged  forty-four,  had  first  attack  of  gonorrhea 
at  twent5^-two,  which  was  quite  severe,  and  continued  for 
several  months,  finally  terminating  in  gleet,  and,  as  he 
thought,  stricture.  He  had  several  mild  attacks  of  acute 
gonorrhea,  the  gleet  continuing  during  the  interim.  He 
had  been  treated  several  times  for  stricture  with  sounds. 
He  suffered  constantly  with  his  back  and  limbs,  and  had 
made  several  trips  to  Hot  Springs,  Ark.,  for  rheumatic 
arthritis.  He  was  always  benefited  by  the  Hot  Springs 
baths,  but  the  pains  would  recur  in  from  four  to  six 
months  thereafter.  Upon  examination  I  found  the  urethra 
slightly  tender  an  inch  back  of  the  meatus,  and  upon  tho 
lower  surface.  The  other  portions  of  the  canal  were 
healthy,  except  the  prostatic;  which  was  very  much  in- 
iiamed.  There  was  no  organic  stricture,  nor  do  I  think 
he  ever  had  any,  though  he  had  been  advised  several  times 
to  submit  to  an  operation  for  such.  The  long  standing 
granular  inflammation  of  the  prostatfc  urethra,  with  the 
enlarged  gland,  had  encroached  upon  the  caliber  of  the 
canal  at  that  point,  narroAving  it  and  obstructing  the  free 
flow  of  urine,  at  times,  when  it  was  acrid ;  and  also  the 
free  entrance  of  an  instrument  to  the  bladder. 

The  gland  was  swollen  as  determined  through  the 
rectum,  and  painful  upon  pressure,  which  was  reflected 
to  the  gians  penis.  Both  lobes  of  the  gland  were  equally 
involved.  Immediately  opposite  the  prostate,  upon  the 
front  rectal  surface,  was  an  elliptical  ulcer  an  inch  and 
one-half  long  and  three-fourths  of  an  inch  wide.  The 
vesicles  were  also  tender,  and  the  rectal  mucosa  opposite 
them  was  inflamed  and  thickened  but  not  abraded.  After 
several  examinations  of  prostatic  expressions  gonococci 
were  finallv  discovered. 


SEMINAL  VESICLES.  105 

The  acute  symptoms  were  treated  as  before  detailed, 
which  was  followed  by  cataphoresis,  using  one  per  cent 
solution  of  ichthyol,  through  the  prostatic  urethra.  The 
prostate  and  vesicles  were  treated  at  first  with  the  second- 
ary  faradic,  followed  with  the  sinusoidal  current. 

The  ichthyol  had  a  very  happy  effect  in  this  case,  and 
was  the  only  remedy  used.  Eecovery  was  rapid,  and  there 
has  been  no  return  of  jDains ;   it  has  been  three  years  since. 

Case   IX. — Enlarged  Prostatitis,  Cystitis. 

Bachelor;  aged  sixty-nine;  robust,  had  led  an  outdoor 
life.  He  had  gonorrhea  in  early  manhood,  and  quite  a 
number  of  attacks  thereafter.  He  had  suffered  with  his 
bladder  and  prostate  for  fifteen  years,  and  had  been  treated 
by  massage  of  the  gland,  sounds,  irrigation  and  cautery 
applications  to  the  deep  urethra.  He  had  just  left  a 
genito-urinary  specialist  when  he  consulted  me,  who  had 
treated  him  with  large  sounds  daily  for  six  weeks. 

He  was  suffering  with  frequent  and  painful  urination, 
voiding  it  on  an  average  of  every  thirty  minutes  during 
the  da}^,  and  hourly  at  night.  The  urine  was  of  light 
color,  laden  with  mucus,  pus,  urea  and  of  ammonical  odor. 
I  did  not  attempt  an  examination  at  this  stage,  but  gave 
him  five  grains  of  cystogen  every  four  hours,  alternating 
with  twenty  minims  of  the  normal  tincture  of  hyoscyamus 
to  the  drachm  of  triticum  repens.  In  conjunction  with 
this,  a  suppository,  containing  ten  grains  of  boric  acid  and 
one-half  grain  of  belladonna,  was  introduced  into  the 
rectum  night  and  morning.  Eest  in  bed  was  also  enjoined. 
After  three  days  the  acute  symptoms  had  been  allayed, 
when  an  examination  revealed  a  congested  enlargement  of 
the  prostate,  prostatic  urethritis,  and  cystitis.  He  had  been 
washing  out  the  bladder  with  boric  acid  daily,  which  I  had 
him  discontinue. 


lOG  PROSTATE  GLAND  AND  ADNBXA. 

He  was  treated  similarly  to  those  before  described,  after 
acute  symptoms  had  been  allayed.  His  improvement  was 
rapid,  and  at  the  end  of  the  third  month  the  urine  was 
cleared  up,  and  voided  about  four  times  during  the  day 
and  once  through  the  night.  He  would  occasionally  pass 
the  night  without  having  to  get  up,  then  again  he  would 
have  to  pass  his  urine  twice  in  the  night.  After  his  return 
home  he  continued  to  improve  until  conditions  were  about 
normal  for  a  man  of  his  age. 

Five  years  later  he  began  having  some  difficulty  in  start- 
ing the  flow  of  urine;  then  periodical  hemorrhages  would 
occur.  By  cystoscopic  examination  I  detected  a  sma'U 
vegetative  growth,  almost  the  size  of  the  end  of  one's  small 
finger,  attached  to  the  lower  part  of  the  neck  of  the  blad- 
der. It  was  highly  vascular  and  would  bleed  freely  when 
touched.  Its  free  extremity  floated  about  the  vesicle  ori- 
fice and  acted  as  a  valve  that  at  times  shut  off  the  flow  of 
urine.  I  had  an  electrode  made,  the  metal  part  of  which 
hooked  around  the  tumor,  so  as  to  affect  it  only ;  the  metal 
end  of  the  electrode  was  perforated  that  medicinal  reme- 
dies could  be  applied,  thus  procuring  the  combined  effects 
of  electrolysis  and  cataphoresis.  After  the  third  week's 
treatment  it  ceased  to  bleed,  became  less  tender  and  showed 
much  atrophy.  Six  months  afterwards  hemorrhage  again 
recurred.  Cystoscopic  examination  revealed  a  short  pedical 
of  the  tumor  with  an  abraded  surface.  This  was  promptly 
healed  and  he  has  had  no  further  trouble  with  it. 

Similar  patients  have  come  under  my  care,  suffering 
with  vegetative,  polypoid,  vascular  or  semi-fibroid  tumors 
protruding  from  the  base  of  the  prostate  into  the  bladder, 
which  act  as  a  valve  to  obstruct  the  passage  of  urine.  Some 
of  these  cases  have  yielded  readily  to  the  treatment  as 
described;  others  have  been  persistent  and  unyielding. 
Those  that  have  proven  so  rebellious  to  treatment  have 
been  of  fibrinous  character. 


SEMINAL  VESICLES.  107 

It  has  been  necessary,  in  some  of  the  latter,  to  use  the 
electric  cautery,  as  illustrated.     (Fig.  XVI.) 

Case  X. — ^Cheonic  Enlaeged  Prostatitis,  Vesiculitis, 
AND  Cystitis. 

The  patient  was  seventj^-two  j^ears  of  age,  costive,  con- 
stant pain  in  back  and  perineum,  the  latter  necessitating 
his  using  a  rubber  cushion,  hollowed  out  in  the  center,  to 
sit  upon.  The  urine  was  alkaline,  heavily  laden  with 
mucus  and  pus,  one-fifth  of  which  would  be  a  semi-solid 
mass  upon  settling;  and,  at  times,  strongly  ammoniacal. 
Fecal  matter  passed  in  lumps  or  flattened.  He  had  been 
treated  by  the  usual  methods,  with  sounds  and  irrigations. 
The  prostate  was  very  large  but  not  tender  upon  pressure. 
The  vesicles  were  similarly  affected.  The  prostatic  urethra 
was  quite  tender.     He  had  a  constant  urethral  discharge. 

Urethral  and  rectal  applications  were  used  to  the  pros- 
tate for  six  weeks.  The  improvement  was  most  marked  in 
every  way.  He  returned  home,  where  he  remained  two 
months,  then  came  back  for  further  treatment.  He  was 
now  able  to  ride  about  in  his  bugg}',  dispensed  with  his 
cushion,  but  was  still  unable  to  evacuate  his  bowels  with- 
out the  use  of  medicines.  There  was  only  a  trace  of  sedi- 
ment in  the  urine,  and  the  urethral  discharge  was  scarcely 
perceptible.  He  remained  under  treatment  four  weeks  at 
this  time.  The  prostate  was  reduced  almost  to  normal, 
the  urine  had  changed  to  an  acid  reaction,  free  from  sedi- 
ment, and  with  specific  gravity  of  22.  He  was  free  from 
pain.  He  returned  home  and  I  did  not  see  him  again  for 
two  years.  He  had  been  comfortable  during  all  this  time, 
with  the  exception  that  he  occasionally  had  quite  copious 
and  irritative  urethral  discharge.  Upon  examination  at 
this  time  I  found  the  prostate,  about  normal  in  size  and 
non-sen«itive.     The  vesicles  were  tender,  and  the  rectal 


108  PROSTATE  GLAND  AND  ADNEXA. 

mucosa  surrounding  them  thickened,  and  unduly  red. 
Applications  of  five  per  cent  strength  of  picric  acid  was 
used  directl}'  to  the  vesicles  with  the  sinusoidal  current 
daily.  The  first  treatment  was  followed  with  diminution 
of  the  urethral  discharge.  This  discharge  had  also  ren- 
dered the  prostatic  urethra  tender,  which  required  similar 
treatment.  At  the  expiration  of  two  weeks  he  was  dis- 
missed. I  heard  from  him  some  time  after  he  returned 
home,  stating  that  there  had  heen  no  return  of  the  dis- 
charge, and  that  he  was  riding  horse-back  averaging  fifteen 
miles,  almost  daily. 

Case  XI. — Congested  and  Enlarged  Prostate,  Ureth- 
ritis, Eheumatig  Arthritis. 

Married;  good  physique;  aged  forty-eight.  He  had 
been  confined  to  bed  for  four  or  five  months  prior  to  seeing 
me,  with  polyarthritis.  He  had  been  dosed  with  all  the 
rheumatic  remedies  about  which  the  profession  have  any 
knowledge,  with  only  temporary  relief.  There  was  little 
or  no  swelling  of  the  joints,  but  they  were  attended  with 
much  pain  and  creaking  when  moving  them.  He  was 
unable  to  dress  himself,  but  was  able  to  walk  about.  The 
prostate  gland  was  very  tender,  both  through  the  urethra 
and  rectum.  There  was  no  apparent  urethral  discharge, 
though  the  prostatic  part  of  the  canal  was  very  sensitive. 
He  began  improvement  after  the  first  week,  and  the  stiff- 
ness and  pain  in  the  joints  left  him  at  the  end  of  three 
months'  treatment  of  the  prostate  and  vesicles  by  cata- 
phoresis. 

Case   XII. — Enlaeged  Prostatitis,   Cystitis,  Eheu- 
matig Arthritis. 

Bachelor;  aged  thirty-eight,  of  robust  physique.     Had 
gonorrhea  at  twenty-two,  followed  by  several  attacks.    For 


SEMINAL  VESICLES.  109 

eight  years  he  suffered  with  frequent  micturition,  both 
day  and  night.  There  was  little  or  no  discharge.  He 
began  suffering  at  first  with  pains  in  his  hips  and  calves 
of  legs;  then  in  his  wrists  and  shoulders.  There  was  no 
swelling  of  the  joints.  He  was  occasionally  troubled  with 
fortuitous  seminal  discharges,  which  was  followed  by 
impotency. 

The  prostate  was  only  slightly  enlarged,  but  quite  ten- 
der, both  through  the  urethra  and  rectum.  He  was  treated 
at  one  time  with  sounds,  but  more  recently  by  massage  of 
the  prostate.  The  latter  was  very  painful  to  him.  Four 
weeks'  treatment  by  means  of  cataphoresis  effected  a  per- 
manent cure. 

Case   XIII. — Enlarged  Prostatitis,,   Cystitis.  Pros- 
tatic Calculi. 

A  mechanic,  aged  sixty-two,  married.  Xo  gonorrheal 
history.  He  had  never  taken  a  drink  of  alcoholic  liquors 
nor  used  tobacco  in  any  form.  Up  to  his  fifty-fifth  year 
he  was  free  from  any  symptoms  of  disease  of  the  bladder. 
prostata  or  kidneys.  About  that  time  he  began  passing 
urine  more  frequently  than  normal  and  it  became  notice- 
able when  chilled,  or  his  feet  were  wet,  that  it  irritated  his 
bladder,  which  necessitated  him  to  evacuate  his  bladder 
more  frequently,  both  day  and  night.  He  resorted  to  the 
ordinary  domestic  remedies  with  temporary  relief.  Sub- 
sequently he  began,  during  paroxysms  of  dysuria,  to  pass 
some  blood  at  the  cessation  of  the  flow.  The  hemorrhage 
became  more  marked  in  time,  and  was  accompanied  with 
pain  in  region  of  the  perineum  and  bladder.  All  symp- 
toms increased  in  severity,  compelling  him  to  seek  relief. 
He  then  consulted  a  genito-urinary  specialist,  who  began 
the  use  of  sounds.  This  aggravated  his  symptoms.  He 
next  underwent  the  Bottini  cautery  operation.     This  was 


110  PROSTATE  GLAND  AND  ADNEXA. 

followed  by  some  temporary  relief,  when  he  relapsed  into 
still  worse  condition  than  before  the  operation,  and  was 
confined  to  his  bed  for  several  weeks  with  some  form  of 
fever.  On  recovering  from  the  fever  he  came  to  me  for 
treatment. 

He  was  very  much  emaciated,  anemic,  and  voiding  urine 
on  an  average,  during  the  day,  of  every  fifteen  minutes, 
and  at  night  about  every  forty  minutes.  He  suffered  with 
constant  pain  in  his  back.  The  urine  was  strongly  alkaline 
and  contained  a  heavy  sediment  of  mucus  and  pus,  of 
ammoniacal  odor,  and  occasionally  tinged  with  blood. 

I  began  treatment  by  giving  him  five  grains  of  cystogen 
three  times  daily,  and  ten  minims  of  normal  tincture  of 
hyoscyamus  every  three  hours  during  the  day.  Locally,  I 
applied  benzoinol  to  the  urethra,  and  the  secondary  faradic 
current,  with  fifteen  thousand  ohms  resistance,  to  the  pros- 
tate through  the  rectum.  He  was  also  given  a  suppository 
containing  ten  grains  of  boric  acid  and  three-fourths  of  a 
grain  of  extract  of  belladonna  at  night.  This  treatment 
rendered  him  much  more  comfortable,  and  prolonged  the 
intervals  of  micturition.  At  the  expiration  of  two  weeks 
his  condition  was  so  much  improved  that  I  began  the  use 
of  cataphoresis  through  the  urethra,  and  the  sinusoidal 
applications  to  the  gland  per  rectum.  This  treatment  was 
continued  regularly  for  two  months,  with  marked  improve- 
ment. 

He  returned  to  work  handling  heavy  machinery,  and  I 
did  not  see  him  again  for  three  months,  when  he  returned 
with  the  same  symptoms  somewhat  aggravated.  Treatment 
was  again  resumed  with  variable  results:  at  times  there 
would  be  much  improvement,  then  he  would  relapse  into 
his  former  condition.  During  all  this  time,  however,  he 
was  continuously  at  work  carrying  heavy  machinery.  One 
day  following  a  treatment  of  urethral  cataphoresis  to  the 


SEMINAL  VESICLES.  Ill 

prostate  he  passed  quite  a  quantity  of  prostatic  concre- 
tions, varying  in  size  from  a  pin  point  to  a  mustard  seed, 
as  illustrated  by  Fig.  XIII,  page  87. 

He  finally  became  discouraged  with  my  treatment  and 
sought  the  advice  of  another  physician. 

I  did  not  hear  anything  further  from  him,  but  about 
one  month  thereafter  I  incidentally  noticed  an  account  of 
his  death  in  a  hospital  as  a  result  of  an  operation.  I  never 
learned  the  nature  or  purpose  of  the  operation. 

Case  XIV. 

Was  similarly  affected  to  that  of  the  foregoing.  He, 
too,  had  been  operated  upon  with  the  Bottini  cautery  and 
by  the  same  physician.  On  the  fifth  day  after  the  opera- 
tion he  had  a  violent  hemorrhage  which  lasted  several 
hours,  rendering  him  unconscious  and  almost  pulseless. 
The  hemorrhage  was  finally  controlled  after  many  hours' 
work  by  the  physician.  This  patient  was  treated  in  similar 
way  to  the  preceding  one,  and  improved  more  rapidly.  In 
fact,  he  was  so  far  relieved  of  irritation  about  the  bladder 
and  prostate  that  I  thought  at  one  time  he  would  ulti- 
mately recover,  but  he,  too,  had  some  operation  performed 
upon  his  bladder  or  prostate,  and  I  have  never  since 
learned  the  result. 

In  these  cases  there  were  no  indications  for  the  Bottini 
operation ;  and  I  do  not  hesitate  to  state  that  it  was  made, 
as  I  have  known  of  others,  in  an  empirical  manner,  with- 
out reference  to  the  exact  diagnosis  of  the  condition  of  the 
prostate.  The  bleeding,  as  result  of  the  operation,  relieved 
for  a  time  the  congested  state  of  the  gland,  and  it,  together 
with  long  rest  in  bed,  relieved  temporarily  the  inflamma- 
tion, but  at  the  expense  of  the  irreparable  injury  to  the 
gland,  as  denouement  of  the  cut  and  cicatrix.  The  only 
indication  where  such  an  operation  is  at  all  justifiable  is 


112  PROSTATE  GLAND  AND  ADNEXA. 

in  those  cases  where  an  obstruction  forms  at  the  neck  of 
the  bladder  by  way  of  a  firm  fibrinous  band;  or,  in  other 
words,  wliere  there  is  a  development  of  the  third  or  middle 
lobe  of  the  prostate.  When  the  latter  condition  exists  to 
such  an  extent  as  to  obstruct  the  flow  of  the  urine,  it  may 
be  severed  with  little  danger  to  life,  either  directly  or 
indirectly,  and  especially  after  the  case  has  been  prepared 
for  such  an  operation  by  the  reduction  of  acute  congestion 
and  inflammation.  This  treatment  will  be  considered  more 
at  length  in  the  succeeding  chapter  under  the  treatment 
of  the  hypertrophied  prostate. 

Case   XV.  —  Prostatitis,  Vesiculitis,   Peostatic 
Urethritis,   Sympexia,  Hemiparesis. 

Merchant;  married;  aged  fifty-five;  gonorrheal  his- 
tory. He  had  been  treated  several  times  by  means  of 
sounds,  massage  of  the  prostate,  internal  medication,  etc., 
— the  same  result. 

Examination  showed  an  enlarged  and  inflamed  prostate, 
perivesiculitis  and  inflammation  of  the  neck  of  the  bladder. 
The  right  leg  became  impaired  and  grew  gradually  worse; 
then  the  arm  and  hand  on  that  side  followed  after  a  year's 
existence  of  the  trouble.  There  were  various  shaped  lumps 
of  a  tenacious  character  that  passed  from  the  urethra,  at 
times  following  the  evacuation  of  the  bladder  in  the  last 
efforts  to  expel  its  contents  and  again  on  evacuating  the 
bowels  when  costive.  There  was  a  perverted  sexual  pro- 
pensit}^,  often  a  previous  discharge  of  semen  during  sexual 
congress,  then  again  a  condition  of  inertia. 

The  gland  was  enlarged  and  inflamed,  the  rectal  mucosa, 
around  the  vesicles,  was  thickened  and  unduly  red.  The 
prostatic  urethra  was  very  tender.  The  lumpy  discharges 
(sympexia)  consisted  of  mucus,  calcareous  matter  and 
disintegrated  semen. 


SEMINAL  VESICLES.  113 

He  was  anemic,  emaciated,  costive  and  dyspeptic. 
Cascara  was  given  to  relax  the  bowels.  Cataphoresis  was 
given  by  way  of  urethra  and  rectum,  through  the  prostate, 
after  the  preliminary  course  to  relieve  acute  symptoms. 
Complete  recovery  followed  five  months'  course  of  treat- 
ment. The  lame  leg  was  somewhat  sluggish  and  heavy 
for  a  year  afterwards,  but  finally  regained  its  normal 
condition. 

Case  XVI. — Enlarged  Prostate,  Cystitis. 

Farmer;  aged  sixty-one;  married.  He  had  gonorrhea 
in  early  youth,  but  recovered  from  it  with  little  incon- 
venience. He  had  little  or  no  trouble  until  about  in  his 
fifty-fifth  year,  when  he  noticed  the  necessity  of  evacuating 
the  bladder  more  frequently  than  natural  through  the  day; 
and  having  to  arise  once  or  twice  during  the  night.  This 
continued,  worse  at  times,  then  better,  until  he  began  pass- 
ing some  blood  with  the  urine,  during  the  periods  of 
exacerbation.  In  addition  to  the  enlarged  and  con- 
gested gland  the  cystoscope  revealed  some  small  vegetative 
growths  about  the  size  and  shape  of  the  tip  of  a  sharpened 
pencil.  These  were  touched  with  a  very  small  quantity  of 
crystal  phenic  acid,  then  dried  with  a  piece  of  absorbent 
cotton  so  as  not  to  smear  the  acid  over  a  large  area.  Cata- 
phoresis was. then  used,  and  recovery  followed.  The  man 
grew  to  be  quite  robust. 


CHAPTER  VI. 

HTPEETROPIIY  OF  THE  PROSTATE. 

True  hypertrophy  of  the  prostate  consists  chiefly  in 
indurated  enlargement,  as  an  outgrowth  of  the  muscular 
fibers  of  the  gland.  The  pressure  as  exerted  by  this  adven- 
titious tissue  upon  the  blood  vessels  and  gland  tissue  per- 
verts their  function,  and  ultimately  induces  parenchy- 
matous inflammation  of  the  entire  gland.  This  form  of 
disease  is  characteristic  of  old  age.  It  rarely  occurs  in 
men  under  fifty-five,  and  more  frequently  after  having 
passed  sixty.  Sir  Henry  Thompson  places  the  time  of  life 
at  which  it  most  frequently  occurs  at  from  fifty-five  up  to 
seventy,  but  that  it  rarely  develops  after  seventy.  Dr. 
Keys  places  the  time  of  its  usual  appearance  after  fifty. 
It  must  not  be  inferred,  however,  that  in  all  men  past 
fifty-five,  who  suffer  with  prostatic  disease,  it  is  senile 
hypertrophy;  but  on  the  contrary,  more  men  suffer  from 
congested  enlargement,  during  that  period  of  life,  than 
from  a  hypertrophic  induration  of  the  gland. 

While  this  disease  is  characteristic  of  old  age,  yet  excep- 
tional cases  occur  at  a  much  earlier  period  of  life.  It  is 
quite  common  among  physicians  to  accredit  all  forms  of 
diseases  of  the  prostate  to  hypertrophy  and  place  the  time 
of  its  occurrence  anywhere  from  twenty-one  up.  In  fact 
many  chronic  urethral  diseases  that  have  proven  rebellious 
to  the  ordinary  methods  of  treatment  have  been  pro- 
nounced hypertrophy.  It  might  be  likened  to  Fothergill's 
interpretation  of  rheumatism,  which,  as  he  states,  "in- 
cludes the  lightning  pains  of  locomotor  ataxia  to  the 
boring  sensations  of  syphilitic  ostitis." 

114 


115 


XVIII. 


Fix.  XVIII.  illustrates  a  condition  of  true  hypertrophy 
of  the  prostate,  showing  extensive  growth  of  the  third 
lobe,  which  so  encroaches  upon  the  neck  of  the  bladder  as 
to  occlude  the  flow  of  urine.  It  also  shows  an  extension 
of  inflammation  to  the  bladder,  vesicles  and  rectum. 


116  PROSTATE  GLAND  AND  ADNEXA. 

Clinical  experience  has  demonstrated  that  the  large 
majority  of  men  troubled  with  prostatitis  even  past  fifty 
do  not  suffer  from  hypertrophy  of  the  gland,  but  of  con- 
gested enlargement.  I  have  treated  and  cured  many  men 
suffering  from  the  latter,  that  had  been  treated  for  senile 
hypertrophy  and  pronounced  incurable.  Such  errors  have 
not  been  confined  to  the  general  practitioner,  but  many 
had  been  treated  by  some  of  the  leading  genito-urinary 
specialists 

CAUSES.     ' 

The  etiology  of  the  disease  has  never  been  definitely 
determined.  Several  of  the  French  writers  have  consid- 
ered it  analogous  to  the  atheromatous  condition  of  blood 
vessels,  heart  and  other  structures  of  the  body,  due  to  old 
age,  and  as  result  of  undue  accumulation  of  the  earthy 
salts  from  the  impaired  functions  of  the  eliminative 
organs.  The  various  hypotheses  as  advanced  by  different 
writers  upon  the  subject  are  wholly  speculative.  It  cannot 
be  due  to  over  use  of  the  organs,  congestion,  or  inflamma- 
tion of  the  gland  of  long  standing,  though  the  latter  evi- 
dently tends  in  some  instances  to  convert  soft  infiltration, 
as  a  result  of  such  inflammation,  into  firm  fibrinous  struc- 
ture; yet  I  have  known  of  numerous  men  who  suffered 
more  or  less  with  prostatitis  for  twenty-five  or  thirty  years, 
but  were  free  from  fibrinous  induration  of  the  gland.  Dr. 
Keyes  says :  "The  prostate  is  analogous  to  the  uterus  in 
the  female,  in  regard  to  the  nature  of  the  muscular  tissue, 
which  composes  it,  and  this  analogy  is  further  borne  out 
by  the  tendency  of  both  organs  to  develop  fibrous  tumors 
(so  called)  after  middle  life." 

The  morbific  changes  that  take  place  are  not  uniform, 
as  in  congested  enlargement  of  the  gland,  but  are  usually 
nodular,  or  one  lobe  may  be  affected,  independently  of  the 


HYPERTROPHY   OF   THE   PROSTATE.  117 

other.  The  muscular  band  at  the  neck  of  the  bladder  is 
almost  invariably  involved,  sooner  or  later,  forming  a  firm 
bar  which  serves  to  obstruct  the  flow  of  urine.  This  often 
marks  the  chief  subjective  factor  in  the  first  stage  of  the 
disease.  Later  this  bar  may  develop  to  such  an  extent  as 
to  cause  retention  of  a  part  of  the  urine,  which  undergoes 
decomposition,  inducing  thereby  local  irritation  of  the 
bladder,  tendency  to  the  development  of  calculi,  or 
sepsis.  Subsequently  as  the  induration  increases,  it  presses 
upon  the  vessels  and  gland  structure  until  congestive 
inflammation  supervenes. 

The  abundant  anastomosis  of  the  veins  of  the  prostate 
and  bladder,  with  those  of  the  hemorrhoidal,  causes  venous 
stasis  in  the  rectal  mucosa  resulting  in  the  formation  of 
tumors,  or  an  abraded  mucous  surface  within  the  rectum. 

SYMPTOMS. 

The  symptoms  must  necessarily  vary  with  the  extent  of 
the  disease,  and  most  of  them  are  similar  to  those  of  con- 
gested enlargement  of  the  gland  as  heretofore  described. 
The  enlarged  gland  generally  presses  upon  the  rectum  and 
interferes  with  the  free  evacuation  of  the  bowels,  causing 
constipation,  and  often  flattening  of  the  fecal  matter,  as 
it  passes  the  obstruction.  It  is  also  somewhat  difficult  to 
start  the  flow  of  urine,  at  times,  or  even  to  thoroughly 
evacuate  the  bladder.  The  residual  urine  may  dribble 
away,  even  after  cessation  of  the  flow,  onto  the  clothing, 
to  the  great  annoyance  of  the  man. 

Pressure  upon  the  nerves  of  the  prostatic,  hypogastric 
and  sacral  plexuses  provokes  various  reflex  disturbances. 
Prominent  among  these  are  pains  in  the  back,  hips  and 
limbs,  disturbance  of  the  stomach,  which  is  a  very  common 
sequel  of  any  form  of  prostatic  disease. 

The  bladder  often  becomes  largely  distended,  from  an 


118  PROSTATE  GLAND  AND  ADNEXA. 

over-accumulation  of  urine^  impairing  the  detrusor  urinae 
to  the  extent  that  the}-  are  unable  to  expel  all  the  urine. 
This  residuum  increases  as  the  disease  progresses,  and 
becomes  offensive  from  the  decomposition  of  mucus  and 
urea.  Bacteria  develop  in  large  quantit}^  and  the  patient 
is  in  constant  danger  of  septic  poison.  Sepsis  is  especially 
liable  to  a  catheter  habit,  inasmuch  as  the  microbic  flora, 
always  present  about  the  meatus  or  fossa  navicularis,  are 
carried  by  the  catheter  into  the  bladder  where  conditions 
are  favorable  for  their  development  and  engendering  of 
septic  poison,  as  clinical  investigation  has  proven,  that  it 
has  been  impossible  to  maintain  an  antiseptic  urethra. 

The  catheter  life  of  a  patient  has  been  estimated  at  an 
average  of  from  four  to  five  years.  Sir  Eeginald  Harrison 
gives  this  as  the  average  time.  There  are  exceptional 
eases  on  record,  where  men  have  lived  fifteen  or  twenty 
years  using  the  catheter  several  times  during  the  twenty- 
four  hours. 

DIAGNOSIS. 

The  disease,  for  which  hyperthrophied  prostate  is  most 
likely  to  be  mistaken,  is  congested  enlargement  of  the 
gland,  as  before  described;  and,  it  is  not  easy,  in  many 
instances,  to  differentiate  between  them,  since  each  occurs 
during  the  same  period  of  life,  and  many  of  the  subjective 
symptoms   and  complications   are  concomitant. 

In  the  early  stage  of  hypertrophy  the  diagnosis  may 
easily  be  made.  In  this  the  gland  is  much  less  sensitive, 
unless  it  has  been  subject  to  harsh  treatment  by  sounds, 
caustic  applications  or  other  procedures,  when  acute  in- 
flammation may  have  been  the  result  thereof  instead  of 
the  disease,  per  se. 

In  extreme  old  age,  where  the  disease  had  been  of  long 
standing,  or  complicated  with  cystitis,  vesiculitis  or  rectal 
tesions,    it    becomes    somewhat    difficult    to    differentiate 


HYPERTROPHY   OF   THE   PROSTATE.  119 

between  the  two  conditions.  The  points  upon  which  I 
rely,  after  taking  age  into  consideration,  are  (a)  the 
length  of  time  of  the  noticeable  existence  of  the  trouble; 
(b)  the  presence  or  not  of  a  urethral  discharge  and  its 
character;  (c)  the  general  contour  of  the  gland  as  deter- 
mined through  rectal  examination;  (d)  the  condition  of 
the  prostatic  urethra  and  bladder. 

In  view  of  the  first  consideration,  should  the  patient  be 
under  fifty-five  years  of  age,  the  indications  would  favor 
congested  enlargement,  rather  than  indurated  hypertrophy. 
Should  the  patient,  on  the  other  hand,  he  over  fifty-five 
and  the  trouble  had  been  noticeable  prior  to  fifty,  it  would 
also  be  a  negative  point  to  hypertrophy.  The  long  stand- 
ing existence  of  a  urethral  discharge,  whether  perpetual 
or  intermittent,  favors  congested  enlargement.  Micro- 
scopical examination  revealing  latent  gonococci  or  Bottch- 
er's  crystals  indicates  the  latter. 

In  hypertrophic  conditions  of  the  gland  it  appears  firm 
and  unsymmetrical  to'  digital  examination,  through  the 
rectum.  It  may  be  nodular  from  the  presence  of  tumors 
in  one  or  both  lobes.  Both  lobes  of  the  gland  are  rarely 
of  the  same  size  and  consistency,  and  there  is  little  or 
no  tenderness  upon  pressure,  unless  inflammation  has 
extended  to  the  gland  from  complications  of  the  bladder 
or  rectum,  or  the  extreme  size  of  the  organ  has  obstructed 
the  flow  of  urine  and  caused  a  congested  inflammatory 
state  of  its  glandular  structure  and  bladder.  When  such 
condition  exists,  there  is  often  a  profuse  discharge  both 
from  the  gland  and  vesicles. 

In  enlargement  from  chronic  congestion  the  lobes  of 
the  prostate  are  uniform  in  size,  less  firm,  unless  it  is  very 
much  swollen  and  the  capsule  is  subjected  to  extreme 
tension.  It  is  also  tender  upon  pressure;  the  tenderness 
extending  to  the  gland  penis  or  perineum. 


120  PROSTATE  GLAND  AND  ADNEXA. 

The  bladder  in  the  hypertrophied  state,  and  advanced 
stage  of  the  disease,  becomes  sacculated  as  result  of  some 
of  the  detrusor  urinae  becoming  partially  paralyzed  from 
over  distension.  In  these  sacs  calcareous  matter  is  often 
deposited,  forming  at  times  stones  of  such  size  as  to  be 
detected  easily  by  the  cystoscope,  when  not  covered  by  folds 
of  the  muscular  walls  of  the  bladder.  In  the  majority  of 
instances,  where  calculi  have  become  imbedded  within 
these  sacs,  distension  of  the  walls  of  the  bladder  by  air 
reveals  them  through  the   cystoscope. 

Another  valuable  diagnostic  point  is  that  the  prostatic 
urethra  is  almost  invariably  elongated.  It  is  somewhat 
difficult  to  describe  just  how  to  determine  the  elongation. 

One  familiar  with  urethral  instrumentation  can  detect 
the  passage  of  the  triangular  ligament  and  membranous 
urethra,  and  the  entrance  of  the  prostatic  portion  of  the 
canal,  and,  therefore,  the  distance  traversed  by  the  instru- 
ment before  reaching  the  bladder. 

The  differential  diagnosis  with  reference  to  these  two 
diseases  of  the  gland  are  very  important,  inasmuch  as  one 
condition  is  curable  and  the  other  is  not,  and  the  curable 
one  is  so  often  mistaken  for  the  other,  and  the  patient  sub- 
jected to  dangerous  and  useless  operations,  that  are  irre- 
parable. 

TREATMENT. 

Hypertrophic  prostatic  diseases,  owing  to  their  intracta- 
bility, have  been  made,  by  the  ambitious  surgeon,  the  ob- 
ject of  many  operative  procedures,  each  of  which  chal- 
lenges its  predecessor  in  the  endless  suffering  entailed 
upon  its  victims,  or  in  its  lethal  dangers  supplying  topic 
for  lengthy  discourses  upon  the  superior  claims  of  each 
operation  as  revealed  by  the  autopsy. 

Before  proceeding  to  describe  my  method  of  treatment 
in  cases  of  senile  hypertrophy,  I  shall  briefly  refer  to 


HYPERTROPHY   OF   THE   PROSTATE.  121 

some  aspects  of  the  surgical  operations  by  which  a  radical 
cure  of  the  disease  is  attempted. 

The  prevalence  of  the  disease  has  offered  a  tempting  field 
for  the  exploitation  of  surgical  ingenuity  and  the  innumer- 
able methods  proposed;  those  of  Tobin,  Mercier,  Bottini, 
Harrison,  Dittell,  McGill,  Belfield,  Treves,  Whitehead, 
Dolbean  and  others,  have  one  and  all  found  enthusiastic 
followers  and  formed  the  subject  of  our  medical  literature 
upon  this  subject. 

Surgical  operations  for  the  relief  of  urinary  troubles 
resulting  from  enlargement  of  the  prostate  fall  into  two 
classes.  The  first  consists  of  the  various  methods  by  which 
the  gland  is  attacked  directly;  the  second  embraces  the 
procedures  that  aim  at  reduction  of  the  blood  supply  of  the 
swollen  organ  and  consequently  atrophy  thereof. 

The  direct  interference  of  the  diseased  organ  is  effected 
through  the  urethra  (as  in  the  Bottini  operation),  or  by 
the  perineal  route  (so-called  lateral  prostatectomy),  or  by 
means  of  suprapubic  incision.  By  the  latter  method,  the 
gland,  especially  the  middle  lobe,  is  removed  bit  by  bit 
with  the  rongeur  forceps,  or  a  wedge  is  cut  out  with  scis- 
sors, or  the  organ  is  destroyed  with  Paquelin's  cautery  or 
the  galvano-cautery.  Prostatectomy  by  combination  of 
suprapubic  and  perineal  methods  has  also  its  followers. 

The  operations  undertaken  for  the  purpose  of  reducing 
the  blood  supply  of  the  gland  and  so  bringing  about  an 
atrophied  condition,  are  either  direct  or  indirect  in  charac- 
ter. The  direct  consists  in  ligating  the  arteries  which  feed 
the  prostate,  i.  e.,  simultaneous  ligation  of  both  internal 
iliac  arteries.  The  indirect  method  is  orchidectomy.  The 
theory  on  which  this  procedure  is  based  being,  that  the 
hyperemic  condition  of  the  genital  system  is  produced  by 
nervous  reflex  through  the  presence  and  secretions  of  the 
testicles. 


122  PROSTATE  GLAND  AND  ADNEXA. 

This  multiplicity  of  surgical  methods  of  dealing  with 
the  hypertrophied  prostate  has  its  parallel  in  the  variety 
of  theories  that  have  been  propounded  as  to  the  cause  of 
the  disease,  as,  for  instance,  that  of  Guyon,  who  regards  it 
as  simply  a  part  of  the  constitutional  condition  peculiar  to 
old  age  and  characterized  by  arterial  sclerosis;  or  that  of 
Harrison,  who  regards  the  growth  as  compensatory  in 
character  and  secondary  to  certain  bladder  changes.  Others 
believe  that  prolonged,  ungratified  sexual  excitement 
causes  enlargement  of  the  prostate.  But  here  we  are  met 
with  the  difficulty  of  distinguishing  cause  from  effect,  for 
there  is  plent}''  of  evidence  to  show  that  the  enlarged  pros- 
tate is  a  cause  of  abnormal  sexual  excitabilit}^,  in  some 
eases,  while  in  the  majority  it  has  the  opposite,  of  causing 
impairment  or  total  impotency.  Therefore  it  is  clear  that 
cause  and  effect  may  be  transposed.  In  general  it  may  be 
said  that  nothing  whatever  has  been  demonstrated  as  to  the 
real  cause  of  senile  hypertrophy. 

Each  and  every  one  of  the  surgical  methods  to  which 
I  have  referred  is  open  to  the  most  serious  objections.  It 
must  be  remembered  that  the  patients  upon  whom  they  are 
practiced  are  generally  very  much  reduced  in  health,  that 
the  surgical  operation  is  of  a  particularly  painful  nature, 
and  that  the  results  have  been  either  utterly  unsatisfactory 
or  at  least  equivocal. 

On  account  of  the  celebrity  of  Bottini's  operation  and  to 
show  the  dangers  which  lurk  in  it,  I  will  here  say  a  word  or 
two  regarding  it.  Enrico  Bottini's  galvano-cautery  radical 
operation  for  hypertrophy  of  the  prostate  was  first  per- 
formed in  1875.  The  instrument  as  used  was  catheter- 
shaped,  of  medium  caliber  with  short  beak  carrying  a 
platinum  plate  (f  inch  in  length)  on  a  porcelain  disc. 
The  plate,  rendered  red-hot  by  electric  current,  was  used 
to  cauterize  the  prostate.     In  a  short  time  this  cauterizer 


HYPERTROPHY   OF   THE   PROSTATE.  12'3 

was  discarded  for  a  prostatic  incisor,  the  instrument  con- 
sisting of  a  male  and  female  arm.  A  platinum  knife  (f 
inch  long)  in  the  male  arm  leaves  the  female  arm  on  work- 
ing an  outside  screw,  and  a  cooling  mechanism  prevents 
burning  of  the  parts  by  any  other  portion  of  the  instru- 
ment than  the  knife.  The  incisor  removes  the  mechanical 
obstruction  to  the  outflow  of  the  urine  by  slowly  burning 
a  groove  or  grooves  through  the  enlarged  prostate.  Con- 
siderable modification  of  this  instrument  was  effected  by 
Freudenberg,  who  made  the  knife  of  an  alloy  of  platinum 
and  iridium,  increasing '  thereby  its  hardness  and  power 
of  resistance. 

The  technique  of  the  operation  is  of  the  most  delicate 
nature,  involving  the  length,  direction  and  number  of  cuts 
to  be  made,  the  rapidity  with  which  the}^  ought  to  be  made 
and  the  amount  of  current  necessary  for  heating  the  knife. 
Besides  all  this  there  is  the  danger  of  the  knife's  bending 
sideways  and  the  difficulty  of  removing  it  without  the 
consequent  pain  and  hemorrhage.  It  is  obvious,  there- 
fore, that  even  if  the  operation  had  proved  effective  and 
free  from  dangerous  consequences,  it  would,  from  its  at- 
tendant difficulties,  be  absolutely  lethal  in  its  nature  save 
in  the  hands  of  the  most  skillful  and  experienced  electro- 
surgeon. 

But  even  where  all  the  details  of  the  operation  are  per- 
fectly understood,  where  the  utmost  care  and  skill  are 
brought  to  bear  upon  it,  where  there  is  clear  knowledge 
on  the  part  of  the  operator  of  the  exact  conditions  exist- 
ing in  the  bladder  neck,  the  dangers  are  too  numerous  to 
allow  of  anything  but  a  theoretic  interest  in  the  Bottini 
cautery.  Among  the  dangers  that  attend  its  employment 
are :  absolute  retention  of  urine,  hemorrhage  which  is  apt 
to  occur  from  five  to  ten  days  after  the  incision  when  the 
sloughs  are  thrown  off,  perforation  of  the  urethra,  drib- 


124  PROSTATE  GLAND  AND  ADNBXA. 

bling  and  sepsis.  The  latter  risk  forms  the  most  serious 
objection  to  the  Bottini  method.  Infection  may  take  place 
not  only  through  the  wounds  of  the  prostate,  but  also 
through  the  kidneys.  Soluble  and  insoluble  matter 
ascends  from  the  bladder  through  the  ureters  to  the  pelvis 
of  the  kidney,  enters  the  lymphatic  veins  and  uriniferous 
tubules  and  is  hence  conveyed  to  the  right  ventricle.  The 
foreign  substance  is  then  carried  by  the  current  of  blood 
into  the  other  organs,  principally  the  lungs  and  liver.  The 
risk  of  sepsis  may  be  imagined  when  it  is  remembered  that 
cystitis,  or  the  conditions  preliminary  to  its  development, 
are  present  in  every  case  of  enlarged  prostate.  Numerous 
pathological  changes  are  present  in  the  bladder  lining  as 
well  as  in  the  prostate  gland  and  adjoining  organs,  and  a 
wound  caused  by  the  Bottini  instrument  is  all  that  is 
necessary  to  produce  serious  inflammatory  conditions. 

Even  such  an  enthusiastic  advocate  of  this  operation 
as  Dr.  Willy  Meyer  admits  that  the  dangers  attending  it 
are  real  and  numerous  and  closes  a  discussion  of  them 
with  the  following  significant  remark:  "At  present,  it 
would  seem,  we  are  justified  in  stating  that  the  larger  the 
prostate,  the  greater  its  blood'  supply,  especially  the  more 
enlarged  its  venous  plexuses,  the  more  pronounced  the 
purulent  catarrh  of  the  prostatic  urethra  as  well  as  of 
the  bladder  and  even  of  the  pelvis  of  the  kidney — ^the  more 
dangerous  is  the  operation." 

The  Bottini  operation  might  be  justifiable  in  some  in- 
stances were  it  true,  as  the  operation  purports,  that  the 
disease  is  confined  to  the  indurated  bar  at  the  neck  of 
the  bladder.  But  such  is  not  the  fact  and  on  the  contrary 
the  lateral  lobes  also  present  pathological  changes.  Should 
the  patient  even  survive  the  operation  it  practically  pre- 
cludes any  other  treatment  for  radical  relief,  except  pros- 
tatectomy^  when  it  would  be  extremely  rare  to  survive  two 
operations. 


HYPERTROPHY   OF   THE   PROSTATE.  125 

Eegarding  the  other  surgical  methods  above  referred  to 
but  little  need  be  said  here.  Prostatectomy,  whether  by 
the  suprapubic  or  perineal  route,  or  by  combination  of 
these  methods,  is  always  accompanied  by  the  danger  of 
sepsis,  hypostasis,  and  above  all  of  uremia.  This  opera- 
tion has  become  quite  popular  of  late  years. 

I  fully  concur  in  the  opinion  expressed  by  Dr.  Orville 
Horwitz,  as  published  in  the-  Medical  Times  of  August, 
1901.  In  summarizing  the  results  of  one  hundred  and 
sixty-one  operations  for  the  relief  of  senile  hypertrophy 
of  the  prostate,  he  says :  "With  the  exception  of  ligation 
of  the  internal  iliac  arteries,  prostatectomy  is  the  most 
dangerous  of  any  operation  that  has  been  recommended 
for  the  relief  of  prostatic  obstruction,  due  to  hyper- 
trophy." Orchidectomy,  objectionable  on  real  as  well  as 
sentimental  grounds,  is  doubtful  in  its  results.  Only  a 
few  years  ago,  when  the  operation  was  enthusiastically 
advocated  by  Dr.  J.  Wm.  White,  it  was  quite  frequently 
performed.  Now,  like  others  that  have  their  day,  it  is 
very  rare.  In  three  cases  upon  whom  I  have  noted  the 
operation  they  have  suffered  intensely  from  hysteria, 
melancholia  and  various  other  reflex  nervous  conditions. 
Ligation  of  the  iliac  arteries  is  spoken  of  with  hesitancy 
by  those  who  have  performed  it.  Of  three  cases  reported 
by  Meyer,  he  says  that  one  was  partially  improved,  one 
was  not  improved  at  all  and  one  died.  Suprapubic  drain- 
age (which  is  recommended  by  Sir  H.  Thompson)  is 
distressing  to  the  patient  and  wholly  unsatisfactory,  for 
not  only  is  the  wearing  of  a  urinal  a  source  of  constant 
annoyance,  but  no  device  that  has  been  tried  can  prevent 
leakage,  while  there  is  a  standing  danger  of  infection 
through  the  constantly  open  communication  with  the  air. 


126  PROSTATE  GLAND  AND  ADNBXA. 

THE  AUTHOE^S   METHOD  OF  TREATMENT. 

Having  reviewed  the  pathology,  complications,  and  ob- 
stinacy of  this  most  formidable  disease,  also  the  opera- 
tions that  have  been  devised  for  its  relief,  I  shall  give 
an  outline  of  the  methods  I  have  found  most  effective,  (a) 
for  impending  dangers  to  life,  (b)  to  mollify  distress- 
ing symptoms,  (c)  in  removing  the  morbid  products  of 
the  gland,  without  jeopardizing  the  life  of  the  patient. 

There  are  many  symptoms  and  conditions  of  this  dis- 
ease, that  are  common  to  congested  enlargement  of  the 
gland,  which  require  similar  treatment.  The  methods 
advised  for  the  relief  of  acute  complications  are  espe- 
cially indicated  in  hypertrophy.  Individual  cases,  how- 
ever, necessarily  require  special  treatment,  to  meet  indi- 
cation that  arise  at  different  stages  of  the  disease.  One 
of  the  most  difficult  problems  to  combat,  in  connection 
with  hypertrophy,  is  the  impediment  to  the  flow  of  urine: 
which  engenders  most  of  the  dangerous  sequels  of  the 
disease;  and,  unfortunately,  the  patient  defers  seeking 
relief  until  some  serious  or  distressing  symptoms  prompt 
him.  This  is  generally  followed  by  the  indiscriminate 
use  of  the  catheter,  and  is  often  repeated  from  day  to 
day  until  prostatic  urethritis,  and  cystitis,  is  provoked, 
and  paresis  of  the  detrusor  uringe  results.  The  latter  con- 
dition makes  the  bladder  so  dependent  upon  the  catheter 
as  to  render  it  difficult  to  overcome  the  habit  even  when 
the  cause  of  obstruction  is  removed. 

The  first  indications  for  treatment  is  to  relieve,  in  so 
far  as  possible,  all  acute  symptoms.  As  this  method  of 
treatment  has  been  fully  described  in  the  preceding  chap- 
ter, I  shall  deem  it  unnecessary  to  repeat  here.  As  the 
acute  symptoms  begin  to  subside  the  calls  to  evacuate  the 
bladder  will  become  less  frequent,  and  the  necessity  for 
the  use  of  the  catheter  will  correspondingly  be  diminished. 


HYPERTROPHY   OF   THE   PROSTATE.  137 

It  is  impossible  to  prevent  a  condition  of  urethritis,  just 
30  long  as  a  catheter  must  be  passed  over  an  inflamed 
surface  for  the  purpose  of  the  evacuation  of  the  bladder. 
The  oftener  it  is  passed  the  more  trouble  it  provokes.  I 
do  not  wish  it  understood,  however,  that  I  advise  the  dis- 
pensing with  the  catheter  altogether,  as  it  is  required,  at 
timeS;,  for  the  over-accumulation  of  urine.  The  bladder 
should  be  encouraged  to  expel  its  contents  whenever  it 
can  be  accomplished  without  much  effort  or  straining. 
As  the  acute  symptoms  are  relieved  the  normal  evacuation 
of  the  bladder  becomes  more  easy.  When  the  catheter 
habit  has  been  established,  the  bladder  becomes  sacculated 
and  the  detrusors  in  state  of  inertia.  It  is  not  wise  to 
defer  the  use  of  the  catheter  too  long;  it  is  also  better 
not  to  permit  the  bladder  to  become  too  much  distended, 
as  it  serves  to  impair  its  muscular  walls.  When  the 
hladder  is  very  much  distended,  from  the  accumulation  of 
a  large  quantity  of  urine,  it  should  never  be  entirely 
evacuated  at  one  time,  as  it  is  liable  to  cause  shock  that 
might  prove  fatal. 

In  the  early  stage  of  hypertrophy,  where  the  urine  is 
not  wholly  retained,  but  somewhat  impeded  in  its  flow, 
and  the  prostatic  urethra  has  not  been  rendered  acutely 
sensitive  from  congestion  or  instrumentation,  I  begin  the 
use  of  cataphoresis  both  through  the  urethra  and  rectum. 
The  effect  of  the  current  alone  revives  the  lethargic  con- 
dition and  softens  the  indurated  tissues.  The  medicines 
as  used  in  connection  therewith  aid  in  the  reduction  of 
the  existing  inflammation  and  decomposing  the  abnormal 
products,  that  form  as  result  of  unnatural  growth  of  the 
parts. 

After  having  allayed  the  acute  symptoms,  I  '^'liammer" 
at  the  prostate  both  through  the  rectum  and  urethra  until 
the  indurated  tissue  begins  to  soften,  then  atrophy.     It 


128  PROSTATE  GLAND  AND  ADNEXA. 

takes  quite  a  long  time  in  some  cases,  where  the  gland  has 
become  quite  large,  complications  of  the  bladder  and  rec- 
tum exist,  and  the  health  of  the  patient  impaired.  In 
some  cases  from  six  to  twelve  months  of  treatment  is 
necessary  to  reduce  the  gland  to  that  extent  where  the 
urine  can  be  voided  without  the  use  of  the  catheter.  I 
do  not  advise  continuance  of  treatment  uninterruptedly 
during  all  this  time, — I  generally  advise  constant  treat- 
ment for  six  weeks  or  two  months  after  the  subsidence 
of  the  acute  symptoms,  then  the  patient  is  instructed  to 
wait  one  or  two  months  when  it  is  again  resumed.  The 
amount  of  reduction  of  the  gland  thus  effected  is  per- 
manent. 

There  are  certain  pathologic  changes  that  take  place  in 
the  bladder  walls  as  a  denouement  of  the  obstructed  flow 
of  urine,  which,  in  some  instances,  cause  paresis  of  a 
part  of  its  muscular  fibers  that  form  sacs,  which  retain 
a  certain  amount  of  residual  urine.  In  other  instances, 
from  long  and  continued  use  of  the  catheter,  atrophic 
degeneration  of  the  muscular  coats  of  the  bladder  occurs 
that  so  impairs  its  force  as  to  render  it  useless  for  the 
expulsion  of  the  urine.  Whenever  such  conditions  of  the 
bladder  exist,  fermentation  of  the  residual  urine  is  inevit- 
able, which  results  in  the  development  of  pyogenic  bac- 
teria and  ammonuria.  When  this  trouble  of  the  bladder 
is  due  to  impaired  function,  it  can  be  relieved  by  applica- 
tions of  the  sinusoidal  or  primary  faradic  currents,  which 
restore  its  tonicit}',  and  enables  it  to  expel  its  contents. 
But,  when  it  once  becomes  sacculated,  it  can  never  be  en- 
tirely restored. 

In  the  majority  of  cases  of  true  hypertrophy  the  bar 
at  the  neck  of  the  bladder,  or  the  so-called  third  lobe  of  the 
prostate,  is  the  chief  offensive  factor.  This  muscular  band 
is,  usuall}^  the  first  to  become  indurated  and  enlarged. 


HYPERTROPHY   OF   THE   PROSTATE.  129 

and,  owing  to  its  position,  it  serves  as  the  most  effective 
barrier  to  the  outflow  of  nrine,  by  mechanically  obstruct- 
ing its  exit.  This  condition  exists,  frequently  at  its  in- 
ception, without  tenderness  or  any  inflammatory  symp- 
toms.    Fig.  17  illustrates  this  condition. 


Fig.   XIX.      (Coulson.) 
Showing  enlarged  prostate  with  "third  lobe," 
through  the  base  of    which  a   false  pas- 
sage has  been  made. 

The  Bottini  operation  was  devised,  more  than  a  quarter 
of  a  century  ago,  for  the  special  relief  of  this  trouble.  The 
operation,  as  originally  purported,  properly  used,  and, 
with  strict  reference  to  this  pathologic  condition,  was 
scientific  and  gave  much  temporary  relief.  But,  like  most 
all  valuable  procedures,   it  has  been  greatly  abused,  by 


130  PROSTATE  GLAND  AND  ADNEXA. 

blind  and  indiscriminate  use,  for  almost  every  inconceiv- 
able disease  of  the  prostate  without,  in  many  instances, 
the  first  semblance  of  diagnosis.  I  have  seen  several  men 
upon  whom  the  operation  had  been  performed  where  un- 
mistakable evidence  of  a  congested  enlargement  of  the 
gland  existed  instead  of  indurated  hypertrophy. 

The  objections  to  the  Bottini  operation  are  that  it  gives 
only  temporary  relief,  even  when  properly  used,  and  the 
condition  of  the  gland  correctly  diagnosed.  This  bar,  as 
before  stated,  is  usually  devoid  of  acute  sensitiveness;  but 
the  cicatricial  tissue  following  the  operation  is  always 
exceedingly  tender  and  inflamed.  It  also  favors  develop- 
ment of  vegetative  and  polypoid  growths.  Some  of  these 
form  quite  large  tumors,  which  evidently  result  from 
lesion  by  the  Bottini  operation.  The  cut  by  the  cautery, 
at  the  entrance  of  the  bladder,  is  constantly  bothered  by 
septic  urine,  on  account  of  its  gravitating  to  this  point. 
The  injury  once  performed  is  irreparable.  The  same  may 
be  said  of  all  other  operations  upon  the  gland;  but  there 
are  some  instances  where  neglect  of  timely  treatment 
necessitates  an  operation  for  the  relief  of  impending  dan- 
ger to  life. 

1  do  not  wish  to  be  understood  as  taking  the  stand 
against  all  operations,  as  there  are  some  few  that  are 
imperative,  and  I  advise  them;  but  the  tendency  of  the 
day  is  too  much  in  favor  of  indiscriminate  cutting,  with- 
out reference  to  correct  diagnosis.  Delay  of  treatment  is 
often  responsible  for  serious  pathologic  conditions  necessi- 
tating the  use  of  the  knife ;  but,  as  expressed  by  the  vener- 
able Jacobi:  "The  knife  takes  too  often  the  place  of 
brains." 

In  regard  to  the  Bottini  operation  I  shall  quote  Dr. 
Joseph  B.  Bissell,  in  Medical  Record  of  November  10, 
1900.    He  writes :    "Bottini's  operation  does  not  adequate- 


HYPERTROPHY   OF   THE   PROSTATE.  131 

ly  appreciate  the  cause  of  the  obstruction.  It  does  not 
treat  the  condition  complicating  the  hypertrophy.  It  does 
not  allow  for  drainage  of  a  dirty  wound.  In  a  word  it  is 
unscientific  and  unsurgical.  Bottini  reported  five  success- 
ful cases  in  two  years  with  this  instrument.  Later  he 
modified  it,  so  that  at  present  it  resembles  a  lithotrite,  in 
having  a  male  and  female  blade.  In  the  former  is  a  plati- 
num knife;,  which  leaves  and  returns  to  the  groove  of  the 
female  blade  by  the  turning  of  a  screw,  and  is  connected 
to  an  electric  current.  A  scale  at  the  outer  extremity 
shows  the  depth  of  groove  cut.  A  cooling  apparatus  sur- 
rounds the  instrument  so  that. it  is  kept  free  from  heat 
while  the  knife  is  raised  to  a  white  heat.  Freudenberg 
modified  the  instrument  by  making  the  blade  of  iridium 
alloy,  rendering  it  firmer  and  less  difficult  to  heat,  and 
also  in  various  other  ways  changed  it  greatly  to  its  advan- 
tage." He  further  says:  "Dr.  Willy  Meyer,  to  whose 
writings. on  this  procedure  I  am  indebted,  has  carried  out 
almost  to  perfection  the  methods  and  manner  of  using 
this  instrument.  He  prefers  the  street  current  with  a 
rheostat,  but  a  fifty  ampere  storage  battery  can  be  taken 
to  the  patient's  house,  if  necessary.  Dr.  Meyer's  personal 
cases,  twenty-four  in  number,  show  eight  per  cent  mortal- 
ity directly  due  to  the  operation,  with  thirty-eight  per  cent 
of  cures." 

The  Bottini  operation  is  not  so  simple  or  easy  as,  at 
first  sight,  one  would  expect.  It  is  an  operation  of  de- 
tail, and  one  which  requires  care  and  skill  and  an  inti- 
mate and  clear  knowledge  of  the  exact  condition  of  affairs 
in  the  bladder  neck.  It  is  an  operation  by  no  means  de- 
void of  danger.  Death,  following  suppression  of  urine 
immediately  succeeding  this  procedure,  has  occurred  sev- 
eral times  to  my  personal  knowledge.  Freudenberg  re- 
ports a  case  in  which  he  cut  through  a  fold  at  the  base  of 


132  PROSTATE  GLAND  AND  ADNBXA. 

the  bladder;  sepsis  and  death  resulted.  Perforation  of  the 
urethra  and  sepsis  are  reported.  Pulmonary  emboli  have 
been  found  at  autopsies.  Hemorrhage  is  a  constant 
danger,  and  all  the  greater,  in  that  it  comes  on  at  the  time 
the  sloughs  are  thrown  off,  about  five  or  ten  days  after  the 
incision.  It  may  take  place  earlier.  Cystotomy  and  tam- 
poning have  been  necessary  in  a  number  of  cases,  in  order 
to  save  the  patient's  life.  Absolute  retention  is  not  an  in- 
frequent immediate  result  of  the  operation.  In  one  of 
Meyer's  cases  he  was  obliged,  for  this  cause,  to  tap  the 
bladder  over  the  pubes  for  three  days.  Pain  and  severe 
tenesmus,  almost  unbearable,  are  not  infrequent  complica- 
tions. Bribbling  is  an  occasional  sequel  which  may  be 
permanent.  But  the  most  serious  of  all  the  objections  to 
Bottini's  method  is  the  risk  of  sepsis.  In  every  case  of 
enlarged  prostate  which  comes  to  us  for  treatment  there 
is  already  a  cystitis,  or  all  the  elements  preparatory  to  its 
development.  There  are  present  a  number  of  pathological 
changes  in  the  mucus  and  other  coats  of  the  bladder  as  well 
as  the  tissues  of  the  prostate  gland  and  it«  adnexa.  A 
trauma,  such  as  is  done  by  the  Bottini  instrument,  is  all 
that  is  needed  to  light  up  an  inflammation  in  these  tissues. 
The  destruction  of  a  considerable  amount  of  tissue  in  a 
closed  sac,  and  leaving  it  there  without  a  drainage,  seems  to 
me  to  be  a  surgical  negligence  without  any  excuse.  To  say 
that  it  is  done  with  every  antiseptic  precaution  is  saying 
what  is  impossible.  The  cicatrization  produced  by  Bottini 
is  said  to  prevent  or  complicate  seriously  any  further 
radical  operation  upon  the  gland.  Moreover,  this  pro- 
cedure does  not  take  into  account  the  real  cause  of  the 
obstruction  and  its  sequences,  or  at  least  affects  only  a 
small  proportion  of  them.  If  the  retention,  cystitis,  and 
their  results  were  caused  by  a  bar  or  a  collar  or  other 
obstruction  at  the  lower  portion  of  the  vesical  opening 


HYPERTROPHY   OF   THE   PROSTATE.  133 

only,  the  Bottini  apparently  would  be  the  indicated  oper- 
ation always,  provided  free  drainage  afterward  could  be 
instituted  to  prevent  septic  infection.  A  catheter  tied 
into  the  urethra,  to  my  mind,  is  a  brutal  and  painful  relic 
of  the  dark  ages  of  genito-urinary  surgery.  Most  of  the 
cases  which  have  come  under  my  observation,  that  had 
been  operated  upon  by  the  Bottini  method,  have  been  com- 
plete failures;  in  all  of  these,  however,  with  the  exception 
of  one  case,  the  operation  has  been  contraindicated.  One 
of  these  cases,  I  can  recall,  was  reported  at  a  meeting  of  a 
medical  society  as  a  remarkable  cure,  when  in  less  than 
a  week  thereafter,  I  noticed  his  name  in  the  death  list, 
followed  by  "uremic  poison." 


Fig.   xx; 


Fig.  XX.  illustrates  an  instrument  devised  by  the 
author  for  relieving  this  indurated  enlargement  at  the 
neck  of  the  bladder.  It  is  similarly  constructed  to  that 
of  the  Bottini  instrument,  except  that  the  cauterizing  part 
is  flat  instead  of  a  blade.  It  is  not  intended  to  cut,  but 
sear  the  indurated  surface,  as  illustrated.  This  operation 
is  attended  with  practically  no  danger,  and  converts  the 
hard  resilient  tissue  into  a  soft  granular  surface,  that 
admits  the  action  of  cataphoresis,  and  atrophy  of  the 
obstruction,  without  danger  to  life.  In  fact,  it  seldom 
requires  confinement  of  the  patient  to  his  room  more  than 
one  day.  Many  never  discontinue  work  more  than  an  hour 
or  two,  but  I  always  advise  at  least  a  day's  rest. 

Fig.  XXI.  shows  the  application  of  the  cautery  to  the 
indurated  third  lobe. 


134 


PROSTATE  GLAND  AND  ADNEXA. 


The  technique  of  this  operation  is  first  to  produce  local- 
ized anesthesia  of  the  prostatic  urethra.  This  is  accom- 
plished by  applying,  with  instrument  shown  in  Fig.  IX, 


Fig.     XXI. 

a  twenty  per  cent  solution  of  cocaine;  to  intensify  the 
localized  action  of  the  cocaine  I  use  anodal  cataphoresis. 
I  then  wait  ten  minutes  for  the  action  of  the  anesthetic. 
The  cautery  should  always  be  tested  before  its  introduction 


HYPERTROPHY   OF   THE   PROSTATE.  135 

into  the  urethra,  in  order  to  note  carefully  the  required 
amperage  and  to  see  that  the  apparatus  is  in  perfect  work- 
ing order.  The  cautery  surface  should  be  of  deep  red  color 
and  never  at  a  white  heat.  It  is  held  in  apposition  to  the 
enlarged  bar,  at  firsts  only  one  or  two  minutes.  The 
patient  should  be  retained  in  a  recumbent  posture  for  at 
least  one  hour,  and,  better  still,  two  or  three  hours  after 
the  operation.  The  bladder  should  always  be  evacuated 
prior  to  the  operation,  and  a  soft  catheter  passed  to  see 
that  it  is  thoroughly  emptied.  The  urine  should  be  main- 
tained in  an  antiseptic  condition,  and  if  of  alkaline  re- 
action, benz-ol  cps  or  cystogen  should  be  given.  Thuja  is 
especially  soothing  to  the  genito-urinary  tract  in  some 
cases,  and  can  be  administered  in  combination  with  potas- 
sium citrate  with  much  relief  when  the  urine  is  unduly 
acid.  The  cautery  application  can  be  repeated  within  a 
week  or  ten  days.  Cystoscopic  examination  of  the  gland 
should  be  made  to  note  its  condition  just  before  the 
cautery  is  applied. 

After  the  second  or  third  cautery  application  cata- 
phoresis  through  the  prostatic  urethra  should  be  instituted 
about  every  second  or  third  day  by  means  of  a  one  per 
cent  solution  of  thuja  or  aqueous  extract  of  hydrastin. 
These  treatments  should  be  given  very  mildly  at  first  and 
discontinued  if  attended  with  much  pain  or  hemorrhage. 
In  many  cases  a  copious  muco-purulent  discharge  follows 
the  cautery  application,  as  a  result  of  the  disintegrated 
enlargement.  If  such  discharge  becomes  very  profuse  or 
irritating  to  the  urethra,  an  injection  of  two  grains  to  the 
ounce  of  sulphocarbolate  of  zinc  should  be  used. 

Softening  and  atrophy  of  the  gland  becomes  quite 
noticeable  in  from  one  to  two  months,  and  the  urine  is 
voided  more  easily,  less  frequently  and  becomes  free  from 
the  heavy  muco-purulent  sediment. 


13G  PROSTATE   GLAND  AND  ADNEXA. 

After  the  iecond  month  I  usuahy  discontinue  all  treat- 
r/.-n:  ;:r  a  certain  length  of  time,  Tarvlng  from  three 
vrech;  t;  t~o  months.  By  this  means  the  natural  restora- 
tive processes  are  favored,  after  discontinuance  of  the 
irrits.tion  iicivohed  h"  the  treatment. 

The  mi.iirity  of  ir.i-n  vrho  suS'er  from  hypertrophy  of 
the  tihrd  !:':e  reoyj.ire  treatment  as  heretofore  described, 
f:r  it  h:i5t  a  ye^r.  when  the  gland  becomes  reduced  to 
£u;h  an  extent  as  to  render  them  comfortable  the  remain- 
der of  their  lives.  Others  require  treatment  occasionally, 
every  :r-e.  fv:.  :r  three  years;  and  only  for  a  short  period 
at  a  time.  Tins  treatment  gives  them  an  option  on  living 
many  years  in  comfort,  rather  than  endure  the  suffering 
entaii::.  "y  the  obstructed  flow  of  urine,  or  the  dangers 
directiy  attending  the  knife,  or  its  subsequent  effects. 

There  are  many  cases  of  hypertrophy,  where  a  vege- 
tati"e  or  t'iyr::!  growth  springs  from  the  posterior  part 
of  the  mi  hhe  or  tiiird  lobe  at  the  neck  of  the  bladder,  and, 
floating  in  the  urine,  serves  as  a  valve  to  imj)ede  its  free 
exit.  Sucl'i  conditions  are  especially  suitable  for  this  oper- 
ation. The  in^tr^irr.ent  is  passed  well  into  the  bladder  and 
tovrards  the  :ror-t  surface  :  it  is  then  reversed  and  brought 
bacltvraris  and  forvrards.  when  the  concave  surface  (con- 
taining the  cautery)  engages  the  tumor.  It  is  held  in 
contact  with  the  tumor  about  one  and  one-haK  to  two 
minutes.  The  patient  should  remain  in  bed  for  some  days 
after  the  operation. 

Fig.  XXIa  is  the  author's  special  method  of  applying 
the  electric  ■  i  :ery  through  the  cystiscope  to  a  tumor  or 
"'::i'>t:t:- e  .'rov-;?.  or  nicer  at  or  around  the  neck  of  the 
ijj.iiu.aii  or  pio.-mLe^  that  have  resisted  other  methods  of 
treatment.  This  method  of  treatment  has  entirelv  super- 
seded that  illnstrated  and  described  on  pa?es  1.33  and  134. 
The  advantages  of  this  are  obvious  at  a  glance,  as  one  sees 


PROSTATE  GLAND  AND  ADNEXA. 

what  he  is  doing  and  does  not  operate  blindly.  The 
cautery  blade  can  be  removed  at  the  will  of  the  operator 
as  often  as  desired,  and  he  can  note  the  results  accomplished 
towards  destroying  this  abnormal  condition.  By  this  means 
he  can  control  completely  any  hemorrhage  by  having  the 
blade  at  red  heat  instead  of  white.  In  order  to  operate  by 
this  method  one  requires  a  current  transformer  where  he 
has  the  direct  incandescent,  and  also  a  resistant  converter 
to  chano-e  the  current  from  a  fraction  of  an  ampere  to  that 
of  ten  or  twenty  amperes.  The  cautery  handle  is  so  con- 
structed that  by  means  of  a  set  screw  one  can  make  and 
break  the  circuit  at  the  will  of  the  operator.  The  current 
should  never  be  closed  until  the  cautery  blade  is  in  apposi- 
tion to  the  tumor  or  part  to  be  treated.  The  apparatus 
should  also  be  tried  and  seen  to  work  absolutely  perfect  be- 
fore attempting  the  operation.  There  are  many  cases 
where  there  is  simply  an  obstruction  of  the  outflow  of 
urine  as  a  result  of  the  third  abnormal  lobe  formed  just  at 
the  neck  of  the  bladder.  This  method  should  always  be  tried 
before  resorting  to  the  knife,  as  the  latter  is  not  only  ex- 
tremely dangerous  to  the  patient's  life,  but  even  should  he 
recover  from  the  operation,  he  only  exists  for  a  few  years 
more  or  less  in  misery.  While  this  method  somewhat  simu- 
lates that  of  the  Bottini  cautery,  which  is  a  blind  empirical 
cutting  into  parts  with  cautery  blade  at  white  heat,  without 
knowing  the  extent  or  even  the  amount  of  hemorrhage  that 
takes  place.  So  dangerous  has  been  this  later  operation 
that  it  is  now  practically  abandoned.  Of  course,  there  are 
some  cases  where  the  tumor  at  the  neck  of  the  bladder,  or 
appended  to  the  prostate,  has  become  so  large  and  indolent 
that  nothing  short  of  the  knife  can  promise  even  temporary 
relief.  Besides  m.en  are  so  prone  to  postpone  treatment  of 
this  kind  that  the  morbific  condition  becomes  irreparable. 

Case  XTII. 

A  lawyer;  aged  sixty-eight;  married;  no  venereal 
history.  He  had  observed  some  slight  difBculty  in  voiding 
urine  for  about  five  years.  There  was  no  pain  attending 
the  act,  but  it  required  longer  time  than  normal,  and  some 
effort  to  thoroughly  evacuate  the  bladder.     This  condition 

136a 


Fig.  XXIa. 


HYPERTROPHY   OF   THE   PROSTATE.  137 

gradually  became  more  manifest,  until  he  observed  that 
he  could  not  entirely  empty  the  bladder.  He  then  con- 
sulted his  physician,  who  began  the  use  of  sounds,  and  the 
catheter.  The  urine  became  turbid,  ammoniacal  and  very 
offensive  after  standing.  Washing  of  the  bladder  was 
resorted  to,  without  any  relief. 

When  he  consulted  me  he  had  to  use  the  catheter  from 
four  to  five  times  during  the  twenty-four  hours.  He  was 
enabled  to  expel  by  force,  at  times,  from  one  to  four 
drachms.  It  contained  a  large  quantity  of  mucus  and 
pus,  strongly  ammoniacal  in  odor,  and  alkaline  in  re- 
action. 

Both  lobes  were  hypertrophied  —  the  left  one  more 
marked.  The  bar  at  the  neck  of  the  bladder  was  especially 
large,  and  firm.  There  was  no  tenderness  upon  pressure 
of  the  gland  through  the  rectum.  Its  large  size  obstructed 
the  fecal  discharge,  causing  constipation.  There  was  very 
slight  tenderness  in  the  prostatic  urethra,  notwithstanding 
the  long  use  of  the  catheter. 

I  began  the  use  of  cataphoresis  with  one  per  cent  solu- 
tion of  thuja  through  the  prostatic  urethra  on  alternate 
days.  The  sinusoidal  application  was  made  to  the  gland, 
through  the  rectum,  the  intervening  day,  making  therefore 
daily  treatments  to  the  indurated  prostate.  The  thuja  was 
gradually  increased  to  ten  per  cent  strength.  Five  and 
ten  per  cent  solutions  of  potassium  iodide  were  also  used. 
I  had  him  discontinue  washing  the  bladder.  Five-grain 
doses  of  cystogen  were  given  three  times  daily.  The  use 
of  the  catheter  was  continued  as  required  to  evacuate  the 
bladder.  At  the  end  of  the  first  month's  treatment,  it 
was  necessary  to  use  the  catheter  on  an  average  of  every 
second  day.  At  times  he  would  not  use  it  oftener  than 
the  third  or  fourth  day,  then  again  daily  for  a  few  times. 
The  urine  remained  normally  acid  without  the  use  of 


138  PROSTATE  GLAND  AND  ADNEXA. 

medicine  and  had  become  much  less  ofiensive,  and  the 
sediment  reduced  to  one-fifth  the  quantity  it  formall}' 
contained. 

This  condition  continued,  with  some  interruptions,  for 
four  months.  He  would  occasionally  go  two  weeks  without 
using  the  catheter,  then  again  having  to  use  it  daily  for  a 
few  days.  His  general  health  was  much  improved,  having 
gained  fifteen  pounds  in  weight.  The  treatment  was  dis- 
continued for  a  month,  and  again  resumed,  and  continued 
two  months  longer,  when  he  returned  home.  The  first 
letter  I  received  from  Mm,  a  month  thereafter,  he  was 
somewhat  discouraged.  I  will  quote  his  second  letter. 
which  followed  about  a  month  later : 

'■T)ear  Doctor :  Since  I  wrote  you,  I  have  improved 
in  health,  and  seem  to  be  almost  well.  The  day  after  I 
wrote  my  last  letter,  the  improvement  commenced  in  a 
marked  degree,  and  the  gain  has  been  steady  and  well 
sustained.  I  have  gained  in  weight  and  strength.  My 
digestion  is  good  and  my  bowels  are  working  in  a  natural 
way.  There  is  no  heavy  or  thick  sediment  in  my  urine 
and  no  pain  in  the  bladder." 

I  have  not  heard  from  him  since. 

Case  XYIII. 

Hypertrophy  of  prostate,  cystitis,  proctitis.  Physician, 
aged  sixty-nine;  married;  had  gonorrhea  in  early  man- 
hood, from  which  he  readily  recovered.  He  had  ridden 
horse-back  a  great  deal  up  to  his  sixty-fifth  year,  without 
discomfort.  About  that  time  he  began  to  feel  an  uneasi- 
ness in  the  region  of  the  perineum.  The  flow  of  urine 
had  also  become  sluggish,  and  somewhat  difficult  to  start. 
He  abandoned  the  saddle  for  a  buggy,  when  he  soon  found 
it  necessary  to  use  a  pneumatic  rubber  ring  for  a  seat,  and 
to   empty  the   bladder  with  catheter.     The  catheter  had 


HYPERTROPHY   OF    THE    PROSTATE.  139 

been  in  use  for  more  than  a  year  when  I  first  saw  him. 
His  general  health  was  very  much  impaired. 

ITpon  examination  I  found  the  left  lobe  very  much 
enlarged,  the  right  less  so,  but  quite  nodular.  There  was 
very  slight  pain  upon  pressure  of  the  gland.  The  adjacent 
tissues  were  somewhat  congested  and  tender,  from  ob- 
structed venous  circulation.  The  muscular  bar  at  the  neck 
of  the  bladder  was  very  large  and  firm. 

Failing  to  procure  much  relief  by  means  of  cataphoresis, 
I  restorted  to  cauterizing  the  bar  at  the  neck  of  the  blad- 
der, with  my  modified  Bottini  instrument  (Fig.  XX). 
This  was  accomplished  by  placing  the  patient  in  the  lith- 
otomy position,  with  the  knees  drawn  back,  and  the  limbs 
held  in  position  by  means  of  leg  rests.  The  hypertrophied 
bar  was  thoroughly  cocainized,  using  a  twenty  per  cent 
solution,  with  instrument  (Fig.  IX.)  prior  to  the  opera- 
tion. The  cautery  band  of  the  instrument  was  tested,  be- 
fore its  introduction,  and  only  carried  to  a  deep  red  heat, 
not  white.  It  was  moved  slightly  to  each  side  of  the  in- 
durated bar  in  order  to  act  upon  a  large  surface.  It  was 
allowed  to  remain  two  minutes,  when  the  circuit  was 
broken  and  the  instrument  removed. 

The  patient  was  kept  upon  his  back  for  some  hours,  to 
prevent  the  urine  from  gravitating  to  the  cauterized  sur- 
face, and  twenty  minims  of  deodorized  tincture  of  opium 
were  administered.  There  was  no  hemorrhage  following 
the  operation,  and  very  little  pain.  Elixir  lithamine  was 
given  for  the  purpose  of  maintaining  the  urine  in  an  anti- 
septic condition. 

The  catheter  was  used  as  often  as  required  to  evacuate 
the  bladder.  The  bowels  were  maintained  in  a  lax  condi- 
tion. The  patient  was  permitted  to  go  out  on  the  third 
day.  One  week  after  the  operation  cataphoresis  was  in- 
stituted alternate  days  for  two  weeks.     The  patient  then 


140  PROSTATE  GLAND  AND  ADNEXA. 

passed  from  half  to  one  and  one-half  ounce  of  urine  at 
times.  The  catheter  was  used  from  two  to  three  times 
a  day.  Cauterization  was  again  used  in  the  same  manner, 
three  weeks  after  the  first  treatment,  followed  by  cata- 
phoresis.  Improvement  in  general  health  was  very  marked. 
The  urine  at  times  would  flow  quite  freely  for  two  or  three 
days,  then  become  sluggish,  requiring  the  catheter.  At  the 
end  of  four  months  he  returned  home.  I  have  heard  from 
him  several  times  since.  He  writes  that  he  is  compara- 
tively comfortable,  and  uses  the  catheter  on  an  average 
every  thirty-six  hours;  occasionally  he  goes  two  or  three 
days  without  using  it,  then  again  once  daily. 

Case  XIX. 

Married,  aged  sixty-three;  obstinate  flow  of  urine  had 
begun  two  years  previous;  prostatic  urethra  was  very 
tender.  Frequent  use  of  catheter  caused  daily  hemorrhage. 
Urine,  heavily  laden  with  pus  and  mucus,  was  very  of- 
fensive upon  standing. 

The  first  cauterization  gave  great  relief,  and  checked  the 
hemorrhage  very  materially.  After  the  second  treatment 
there  was  only  a  trace  of  blood.  The  case  was  treated 
similarly  to  the  preceding  one  for  five  months,  when  he 
was  able  to  dispense  with  the  catheter  altogether.  I  still 
use  cataphoresis  once  or  twice  a  month.  The  urine  is  normal 
some  days;  at  other  times  somewhat  cloudy. 

Case  XX. 

Widower,  aged  seventy-one;  very  sallow  complexion  and 
emaciated.  He  had  been  troubled  with  evacuating  the 
bladder  for  at  least  ten  years.  He  had  been  a  very  active 
business  man,  though  of  sedentary  character.  The  disease 
developed  very  slowly.    He  had  led  a  catheter  life  for  three 


HYPERTROPHY   OF   THE   PROSTATE.  141 

years.  During  the  first  year  he  only  used  the  instrument 
about  once  every  second  or  third  day,  then  daily,  and, 
finally,  four  to  eight  times  in  the  twenty-four  hours. 

He  was  very  costive,  dyspeptic  and  anemic.  At  times 
there  was  only  a  trace  of  blood  following  the  use  of  the 
catheter.  The  urethra  was  not  sensitive.  Eectal  and 
urethral  treatment  were  applied  regularly  for  three  weeks 
with  the  view  of  restoring  tonicity  to  the  organs.  Nutri- 
tive tonics  and  massage  were  also  given  at  the  same  time. 

Six  cautery  applications  were  made  during  the  period 
of  seven  months,  cataphoresis  was  used  between  these  treat- 
ments during  the  interim.  At  the  expiration  of  that  time 
he  had  gained  twenty  pounds  in  weight;  his  mental  vigor 
was  restored,  and  he  could  void  urine  during  the  day  with- 
out the  use  of  the  catheter,  but  at  night  was  necessitated 
to  draw  it  once  and  occasionally  twice 

Case  XXI. 

Aged  seventy;  married.  For  about  seven  years  he  had 
been  periodically  annoyed  with  his  "kidneys  and  bladder," 
as  he  expressed  it.  At  first  he  was  troubled  only  about 
every  four  or  five  months,  the  attacks  lasting  two  or  three 
days,  but  not  hindering  him  from  his  business.  The 
paroxysms  continued  to  become  more  frequent  until  he 
consulted  his  physician.  He  suffered  excruciating  pain 
and  vesical  tenesmus,  and  the  physician  resorted  to  the  use 
of  morphia  for  its  relief.  These  paroxysms  had  recurred 
so  often  that  the  patient  had  become  addicted  to  the  use 
of  the  opiate.  When  sent  to  me  by  his  physician  he  was 
taking  from  two  to  three  grains  of  morphia  daily  and  was 
using  the  catheter  every  twenty  to  thirty  minutes  when 
not  under  the  influence  of  the  drug. 

I  placed  him  in  a  hospital  so  as  to  obtain  the  best  care, 
gradually  cut  down  the  amount  of  morphia  each  day,  sub- 


143  PROSTATE  GLAND  AND  ADNEXA. 

stituting  the  following  prescription  for  its  sedative  prop- 
erties : 

E.      Fluid  ext.  hyoscyamus   one  ounce. 

Opium  deod.  tr two  drams. 

Triticum  repens,  q.  s four  ounces. 

M.  Sig. — Teaspoonful  in  water  every  two  or  three  hours. 

When  the  local  irritation  in  the  prostate  and  bladder 
had  somewhat  subsided  I  used  the  cautery  instrument  as 
in  the  preceding  case. 

I  kept  the  patient  at  a  hospital  for  a  month,  during 
which  time  the  use  of  morphia  had  been  completely  abol- 
ished, and  the  use  of  the  catheter  had  been  reduced  to  once, 
occasionally  twice,  in  the  twenty-four  hours.  His  general 
health  had  so  much  improved  that  he  removed  to  a  hotel, 
but  still  had  an  attendant.  He  showed  marked  improve- 
ment from  that  time  on ;  using  the  catheter  less  frequently 
and  having  little  or  no  pain. 

Upon  calling  to  see  him  one  morning,  I  found  he  had 
a  high  fever,  severe  vesicle  tenesmus  and  paroxysmal  pain 
every  few  minutes,  his  condition  being  much  worse  than 
at  any  previous  time.  The  reverse  in  his  condition  was 
the  result  of  his  attendant  deserting  him  to  attend  a  ball 
the  night  before;  the  weather  was  exceedingly  cold,  the 
fire  had  completely  gone  out,  and  the  patient  was  forced 
to  get  up  into  the  cold  room  to  use  his  catheter,  becoming 
thoroughly  chilled  through,  and  the  fever  followed.  The 
condition  increased  in  severity,  ending  in  the  patient's 
death  on  the  third  day. 

The  majority  of  cases  of  hypertrophy  of  the  prostate  that 
have  come  under  my  observation  have  been  so  amenable  to 
cataphoresis  and  local  applications  as  not  to  necessitate  the 
electric  cautery.  It  is  only  in  those  cases  where  the  bar  at 
the  neck  of  the  bladder  has  become  so  large  as  to  obstruct 
the  flow  of  urine,  that  it  has  been  necessary  to  use  the 
cautery. 


HYPERTROPHY   OF   THE   PROSTATE.  143 

There  are  other  cases,  of  rare  existence,  however,  where 
a  pedunculated  tumor  forms  from  the  posterior  border  of 
the  prostate  and  protrudes  into  the  bladder,  in  which  the 
electric  cautery  is  especially  indicated. 

Many  cases,  too,  are  presented  where  vegetative  or  poly- 
poid growths  occur  around  the  vesical  neck,  demonstrable 
by  means  of  the  cystoscope,  which  yield  readily  to  local 
applications,  and  that  do  not  require  electro-cautery.  I 
could  continue  to  report  numerous  cases  with  various  com- 
plications in  this  connection,  but  deem  it  unnecessary  to 
prolong  the  list. 

SYPHILITIC   PEOSTATITIS. 

Little  mention  has  been  made  by  authors  of  syphilitic 
prostatitis.  I,  too,  had  overlooked  it  as  a  prominent  etiologi- 
cal factor  of  prostatitis  until  two  very  characteristic  cases 
had  come  under  my  observation.  There  is  no  reason,  to 
my  mind,  why  the  prostate  should  not  become  subject  to 
the  influence  of  constitutional  syphilis  as  well  as  the  tes- 
ticles. All  cases  of  syphilitic  prostatitis  that  I  have  noted 
have  resulted  from  the  tertiary  form  of  the  disease. 

Case  XXII. 

Aged  forty-four;  single;  sailor.  He  had  had  several  at- 
tacks of  gonorrhea,  the  first  at  about  twenty.  At  about 
thirty  he  had  sj^philis.  He  had  no  recollection  of  secondary 
symptoms.  He  took  constitutional  treatment  for  only  about 
six  months,  and  even  then  not  regularly. 

There  were  blotches  upon  the  lower  and  outer  portion  of 
his  shin  bone,  simulating  syphilides.  His  rectum  was 
badly  ulcerated,  extending  about  three  inches  from  the 
anus.  .  The  prostatic  urethra  was  excessively  tender.  In 
fact,  he  had  most  of  the  symptoms  attendant  upon  chronic 
enlarged  prostatitis. 


144  PROSTATE  GLAND  AND  ADNEXA. 

I  teated  him  by  the  usual  methods  for  prostatitis,  rectal 
ulceration  and  vesiculitis,  ignoring  the  s^^philitic  history 
of  the  case.  He  improved  readily  for  six  weeks  under  the 
local  treatment,  and  then  remained  about  the  same  for  two 
weeks  without  further  improvement.  I  then  discontinued 
all  treatment  for  two  weeks,  when  he  returned,  suffering 
with  syphilitic  orchitis.  There  was  no  pain  in  the  testicle, 
nor  did  it  exhibit  any  inflammatory  symptoms.  There 
were  no  indications  of  its  swelling  during  the  time  he  was 
under  treatment  by  the  urethra,  nor  were  there  any  acute 
symptoms  of  the  prostate  or  bladder.  He  was  advised  to 
apply  lotions  of  hamamelis,  alternating  with  acetate  of 
lead,  and  report  at  the  end  of  the  week.  By  this  time  the 
testicle  had  become  quite  large,  but  not  the  least  tender. 
He  also  began  complaining  of  pains  in  his  lower  limbs.  I 
now  placed  him  upon  potassium  iodide  constitutionally 
and  applied  ten  per  cent  strength  of  oleate  of  mercury 
locally  to  the  scrotum.  This  treatment  was  continued  reg- 
ularly for  a  month,  when  the  pains  had  subsided  in  the 
limbs  and  the  testicle  was  much  reduced  in  size;  besides, 
the  local  irritation  of  the  prostate  was  much  ameliorat&d. 
The  same  or  similar  constitutional  treatment  was  continued 
at  regular  intervals  for  two  years,  which  controlled  pros- 
tatic irritation  better  than  anything  else.  A  second  case, 
very  similar  to  the  foregoing,  except  that  the  tertiary  symp- 
toms were  more  marked  in  the  outset,  yielded  in  like 
manner  and  was  kept  under  control  by  constitutional  treat- 
ment alone,  after  the  local  trouble  had  been  relieved. 

TUBERCULOSIS  OF  THE  PEOSTATE. 

Of  all  diseases  of  the  genito-urinary  organs,  it  requires 
greater  elasticity  of  the  imaginative  faculties  to  diagnose 
this  form  of  disease  of  the  gland  than  that  of  any  other 
organ  of  the  body;  yet  there  are  writers  who  describe  ac- 


TUBERCULOSIS  OF  THE  PROSTATE.  145 

curately  the  tubercular  nodules  as  detected  by  examina- 
tion through  the  rectum.  Of  late  I  have  come  to  look  upon 
it  only  as  a  loop-hole  through  which  to  escape  the  respon- 
sibility of  failure  to  relieve  an  intractable  case  of  chronic 
prostatitis  by  the  means  usually  in  vogue — namely,  the 
sound,  cautery,  massage. 

The  diseased  prostate,  as  much  or  more  than  any  other 
organ  of  the  body,  often  provokes  mental  and  physical  de- 
pression, which  results  in  emaciation,  a  hacking  cough,  and 
prepares  favorable  soil  for  the  development  and  propaga- 
tion of  pulmonary  tuberculosis.  Many  of  such  cases  have 
come  under  my  care  that  have  yielded  readily  to  treatment 
of  the  gland,  and  restoration  to  perfect  health. 

ASPEEMATISM. 

This  is  a  peculiar  and  rare  condition,  in  which  there  is 
a  competent  erection,  and,  at  times,  a  slight  orgasm,  with- 
out ejection  of  semen.  Taylor  says:  "Lesion  of  the  pros- 
tate being  so  often  the  cause  of  aspermatism,  I  always  ad- 
vise an  examination  of  the  gland  through  the  rectum."  He 
claims  also  that  aspermatism  is  caused  by  the  ejaculatory 
ducts  becoming  plugged  up  by  sympexia,  preventing  there- 
by the  escape  of  the  semen  into  the  urethra.  He  mentions 
a  typical  case,  as  reported  by  Beliquet,  where  relief  fol- 
lowed the  escape  of  a  large  quantity  of  sympexia  through 
the  urethra.  Occlusion  of  the  ejaculatory  ducts  by  pros- 
it tatic  calculi  have  been  reported  by  different  authors. 

I  have  observed  two  cases  of  aspermatism  following 
chronic  prostatitis,  one  of  which  was  of  especial  interest 
owing  to  some  novel  symptoms  connected  therewith. 

Case  XXIII. 

A  young  man,  thirty-two  years  of  age ;  single ;  traveling 
salesman.     He  had  been  very  dissipated  for  ten  or  twelve 


146  PROSTATE  GLAND  AND  ADNEXA, 

years  by  way  of  hard  drinking  and  excessive  sexual  indul- 
gence. He  rarely  became  intoxicated,  however,  but  drank 
continuously.  He  had  had  gonorrhea  quite  often,  followed 
by  gleet,  with  which  he  had  suffered  for  the  past  ten  years. 
During  one  of  these  carousing  bouts  he  was  stricken  with 
paraplegia  and  incontinence  of  urine.  He  had  been  in 
this  condition  for  twelve  hours  before  I  saw  him.  The 
urine  was  passing  involuntarily  from  overflow  of  the  blad- 
der, indicating  paralysis  of  sphincter  urinae. 

I  treated  him  for  the  prostatic  trouble,  and  in  about  two 
weeks  he  began  showing  improvement,  which  continued 
steadily  imtil,  at  the  end  of  the  third  month,  he  was  able 
to  stand  upon  his  feet  and  pass  urine  normally.  He  went 
home  and  I  did  not  see  him  again  for  more  than  a  year, 
when  he  returned  to  my  office  walking  with  a  cane.  He 
laid  his  cane  aside  to  show  me  that  he  was  not  forced  to 
use  it,  as  there  was  but  little  indication  of  his  former 
paralysis.  He  reported  that  he  had  had  no  trouble  in  void- 
ing urine  for  some  months ;  but  that  one  peculiar  symptom 
was  that  he  was  able  to  have  an  erection  and  intercourse 
normally  without  passing  semen,  and  without  any  sensa- 
tion in  the  way  of  orgasm.  He  also  stated  that  the  erec- 
tion could  be  produced  at  will  and  maintained  for  an  in- 
definite period,  often  several  hours,  enabling  him  to  com- 
plete the  act  of  intercourse  several  times  with  no  ill  effects 
except  prostration  from  physical  exertion.  I  have  heard 
from  him  several  times  during  the  past  five  years.  He  re- 
ports his  condition  about  the  same  as  when  he  saw  me 
last.     His  health  otherwise  is  good. 

Case  XXIV. 

Was  that  of  a  man  of  forty-eight  years  of  age ;  married ; 
very  corpulent ;  healthy  and  in  perfect  condition  up  to  two 
years  before  seeing  me.    He  had  then  begun  to  suffer  with 


ASPBRMATISM.  147 

chronic  enlarged  prostatitis  and  from  that  time  was  totally 
impotent,  manifesting  all  the  symptoms  usual  in  such 
cases.  He  was  treated,  and  practically  relieved  of  the  symp- 
toms. There  was  a  normal  recurrence  of  the  functions  of 
the  sexual  organs,  enabling  him  to  have  intercourse  with- 
out discomfort.  About  a  year  thereafter,  he  reported  to 
me  that  he  had  begun  to  have  trouble  in  the  way  of  lack 
of  emission  of  semen  during  intercourse.  It  would  pass 
about  midway  the  urethra,  where  it  would  stop,  apparently 
from  lack  of  force  in  the  muscles  to  expel  it.  There  was 
slight  orgasm  during  the  ejection. 

There  are  other  cases  of  aspermia  that  result  from  oc- 
clusion of  the  ejaculatory  ducts  as  result  of  cicatrix  fol- 
lowing prostatic  abscess;  other  cases  have  been  reported 
where  the  ducts  were  closed  by  prostatic  calculi,  thereby 
obstructing  the  passage  of  semen. 

CHRONIC  PRIAPISM. 

In  some  cases  we  meet  with  the  converse  of  impotence 
(impotentis  coeundi)  as  due  to  chronic  prostatitis  and 
prostatic  urethritis.  While  the  initial  causes,  in  most  in- 
stances, of  the  inflammatory  conditions  are  the  same,  yet 
it  is  often  found  that  these  have  been  aggravated  by  the 
use  of  sounds,  caustic  applications  to  the  deep  urethra,  or 
other  violent  measures. 

The  localized  inflammatory  focus,  situated  usually  in  the 
prostate  and  caput  gallinaginis,  reacting  upon  the  sexual 
brain  independently  of  mental  influences,  causes  prolonged 
irritative  erections  that  are  exceedingly  wearing  upon  the 
nervous  system.  These  distressing  erections  more  frequently 
occur  during  sleep,  arousing  the  man  by  their  irritative 
effects  and  disturbing  his  sleep  for  hours  at  a  time.  Para- 
doxical as  it  may  appear,  men  so  effected  are  generally  im- 
potent and  are  incapable  of  obtaining  an  erection  under 


148  PROSTATE  GLAND  AND  ADNEXA. 

normal  influences.  There  are  others  similarly  affected 
where  one  sexual  congress  only  intensifies  the  desire  for  a 
repetition,  which  is  repeated  until  complete  mental  and 
physical  collapse  results. 

Case  XXV.      Chronic   Priapism,    Frostatic   Inflam- 
mation. 

Man,  aged  fifty-four;  healthy  from  all  external  appear- 
ances; very  temperate  and  a  good  business  man.  He  had 
had  one  attack  of  gonorrhea,  from  which  he  had  appar- 
ently recovered.  For  four  years  he  had  been  annoyed  with 
persistent  erections  at  night,  which  would  often  last  two 
or  three  hours  at  a  time,  necessitating  getting  up  and  walk- 
ing the  floor  to  get  relief.  On  attempting  intercouse  there 
was  a  complete  collapse  of  the  organ  and  utter  failure,  re- 
gardless of  all  efforts  and  remedies  used  for  the  purpose. 

He  had  been  subjected  to  the  use  of  sounds,  aphrodisiacs, 
bromides  and  massage  of  the  prostate  without  benefit. 

Immediate  relief  followed  restoration  of  the  inflamed 
gland  and  prostatic  urethra  to  their  normal  condition. 

Case  XXVI. 

A  minister,  bachelor,  aged  forty-two,  and  an  exceedingly 
intellectual  man,  consulted  me  for  chronic  priapism.  He 
had  been  annoyed  with  the  erections  for  about  five  years. 
At  first,  it  only  disturbed  him  at  night,  but  for  the  past 
three  years  it  had  annoyed  him  both  day  and  night.  He 
had  consulted  many  physicians  regarding  the  trouble,  and 
several  had  given  him  different  forms  of  bromides,  which, 
as  he  said,  had  only  served  to  impair  his  mental  faculties, 
without  giving  any  relief  to  his  embarrassing  condition. 
He  requested  me  not  to  give  him  anything  that  contained 
any  of  the  bromides,  as  it  was  necessary  for  him,  in  his 
line  of  work,  to  maintain  an  active  brain.     He  further 


CHRONIC  PRIAPISM.  149 

stated  that  these  erections  often  remained  hours  at  a  time, 
even  during  the  day,  which  maintained  the  organ  in  a  ten- 
der and  often  painful  condition.  He  stated  that  he  had 
lived  a  perfectly  virtuous  life,  and  there  was  no  reason  to 
question  it.  I  explained  to  him  that  the  symptoms  indi- 
cated a  local  inflammation  of  the  prostate  and  adjacent 
organs,  and  that  systemic  medication  could  never  relieve 
it.  The  gland  was  very  sensitive,  and  quite  rebellious  to 
treatment,  owing,  doubtless,  to  his  abstemious  habits. 

After  six  months  of  irregular  treatment  of  the  prostate 
and  prostatic  urethra  the  irritation  subsided  and  there  was 
no  further  trouble  with  the  erections. 

Case  XXVII. 

Physician;  single;  age  thirty-eight;  never  had  gonor- 
rhea. He  began  having  trouble  when  about  twenty  years 
of  age.  He  was  treated  with  sounds  at  first,  without  re- 
lief, then  injections  and  systemic  medications.  "For  the 
past  twelve  years,"  as  he  states,  "he  has  been  tortured  with 
erections,  the  organ  remaining  erect  for  hours  at  a  time. 
There  has  also  been  a  gleety  discharge  for  fifteen  years; 
at  times  it  is  scarcely  noticeable.  Seminal  emissions,  too, 
occur,  at  times,  even  two  or  three  within  a  week,  then  again 
not  for  a  month.  Emissions  now  occur  without  much  sen- 
sation. They  make  me  dreadfully  weary,  causing  pain  in 
back  and  back  of  neck.  I  can't  stand  mental  work,  and  my 
memory  I  find  is  perceptibly  failing.  I  have  treated  my- 
self, and  was  treated  in  New  York  by  two  physicians  for 
two  years,  one  of  whom  gave  me  bromide  of  sodium  and 
ergot  for  the  annoying  erections  without  the  least  benefit. 
The  other  used  cold  sounds  and  massage  of  the  prostate — 
all  of  which  gave  no  relief." 

In  case  of  this  nature  the  prostatic  urethra  and  the 
gland  itself  are  very  tender  and  much  inflamed,  which  on 
being  relieved,  all  other  symptoms  are  allayed. 


150  PROSTATE  GLAND  AND  ADNEXA. 

MAEEIAGE. 

The  question  of  when  a  man  should  marry,  who  has  had 
chronic  gonorrhea,  prostatitis  or  any  perverted  sexual  func- 
tion, has  been  one  of  paramoimt  importance,  and  has 
elicited  much  discussion  and  various  expressed  opinions 
among  genito-urinary  specialists  throughout  the  world. 

Men  suffering  from  one  or  more  of  these  troubles  are 
frequently  advised  to  marry  before  procuring  relief,  which 
has  entailed  untoward  misery,  unhappy  unions  and  often 
separation.  This  subject  was  discussed  at  great  length  at 
the  Sixth  Congress  of  the  German  Dermatological  Society, 
at  Strasburg,  in  1898,  and  it  was  the  concurrent  opinion  of 
those  present  that  just  so  long  as  gonococci  could  be  de- 
tected in  the  secretions,  they  were  infectious. 

One  other  point  upon  which  all  agree  is  that  the  gono- 
cocci do  hide  and  remain  dormant  for  an  indefinite  period 
within  the  prostate  and  adnexa,  and,  while  it  has  been 
proven  that  these  germs  are  especially  susceptible  to  ger- 
micidal agents  when  brought  into  direct  contact  with  them, 
how  are  you  going  to  reach  them  ?  As  Weiss  says :  "What 
means  do  we  possess  to  entice  these  parasites  to  the  sur- 
face ?"  There  is  no  means  known  to  the  profession  of  en- 
ticing them  from  their  hiding  places,  and  the  only  way 
to  get  rid  of  them  is  to  destroy  them  within  the  gland  by 
cataphoresis  or  electro-magnetic  influences. 

There  are  other  diseased  conditions  of  the  prostate,  how- 
ever, not  dependent  upon  gonococci,  that  are  equally  as  es- 
sential to  relieve  before  marital  relations  should  be  ad- 
vised. The  cause  and  treatment  of  these  have  been  given  in 
a  previous  chapter. 


CHAPTEE  VII. 

NEUROSES  OF  THE  PROSTATE. 

The  sexual  organism,  of  which  the  prostate  is  one  of  the 
chief  factors,  is  so  intimately  blended  with  the  central  and 
sympathetic  nervous  systems,  that  disease  of  this  gland 
provokes  the  most  varied  neurotic  disturbances. 

The  lumbar  spinal  center,  sacral  plexus  and  great  sciatic 
nerve  of  the  cerebro-spinal  system  and  the  hypogastric 
plexus  of  the  sympathetic,  are  in  such  close  reciprocal  rela- 
tion to  the  nerves  of  the  prostate,  that  disturbances  in  the 
organs  to  which  the  former  are  distributed  are  frequently 
the  first  precursors  of  disease  of  the  gland. 

Often  have  I  seen  men  who  had  been  dosing  their  stom- 
achs for  dyspepsia,  their  livers  for  torpor,  their  bowels  for 
constipation,  their  heads  for  neuralgia,  treating  sciatica  for 
malaria,  plastering  their  backs  for  Bright's  disease,  taking 
sea  voyages  for  melancholia,  when  the  origin  of  their  trouble 
was  centered  in  the  prostate,  and  the  relief  of  which  cured 
their  other  ailments.  There  are  many  of  these  cases,  too, 
that  have  no  subjective  symptoms  directly  pointing  to  dis- 
ease of  the  gland,  yet  upon  examination  the  objective  symp- 
toms would  be  most  marked. 

The  erroneous  idea  that  prevails  among  many  physicians 
and  the  majority  of  laymen  that  disease  of  the  prostate 
only  results  from  some  venereal  disease,  or  is  a  sequel  of 
senility,  deters  them  from  an  examination  of  the  gland  for 
these  obscure  troubles. 


161 


152  PROSTATE   GLAND   AND   ADNBXA. 

NEUEASTHENIA. 

This  is  one  of  the  most  prominent  sjanptoms  in  diseases 
of  the  prostate  and  is  manifested  in  almost  every  conceiv- 
able form  of  nervous  disturbance.  The  disease  so  com- 
monly referred  to  as  "nervous  prostration"  might,  in  the 
large  majority  of  instances,  be  traced  to  the  prostate,  should 
the  attending  physician  take  the  care  to  examine  the 
patient  for  this  trouble.  The  examination  is  easily  made, 
and  even  should  such  trouble  not  exist,  it  is  better  to  be 
aware  of  the  fact,  and  so  dismiss  one  probable  etiological 
factor  than  to  continue  groping  in  the  dark  and  dosing  the 
patient  "ad  nauseam."  Because  of  the  almost  universal 
belief  of  both  doctors  and  laymen,  that  to  suggest  disease  of 
this  gland  would  imply  that  at  some  time  in  life  the  patient 
had  had  some  form  of  venereal  disease,  the  physician  is 
loth  to  make  such  suggestion.  And,  even  should  he  muster 
courage  to  do  so,  he  would,  in  all  probability,  be  met  with 
the  prompt  reply,  "Why,  doctor,  I  never  had  any  disease 
there  in  my  life."  It  has  been  difficult  for  me  at  times  to 
convince  people  that  these  troubles  are  not  always  the  re- 
sult of  venereal  disease.  But,  when  the  patient  understands 
that  the  doctor's  desire  to  know  positivel}^  that  no  such 
disease  of  the  gland  exists  is  in  order  to  discard  it  as  a  pos- 
sible cause,  the  patient  will,  in  almost  every  case,  submit  to 
an  examination,  and,  by  means  of  the  lougie  a  hoiile  the 
trouble  in  the  prostatic  urethra  will  be  detected.  The  ex- 
amination through  the  rectum  or  by  cystoscope  could  be 
made  at  the  time,  or  on  some  other  day,  should  ob- 
jection be  made.  Many  cases  of  nervous  troubles  of  an 
obscure  origin  have  been  cleared  up  in  this  way. 

Sexual  neurasthenia  is  not  an  idiopathic  disease,  and 
rarely,  indeed,  can  it  not  be  traced  to  the  prostate  or  genital 
organs  as  the  prime  cause. 


NEUROSES  OF   THE  PROSTATE.  15^ 

I  remember  hearing  a  lecturer,  at  the  Blockley  Hospital, 
Philadelphia,  say  that  he  had  often  declared  that  he  would 
not  vote  for  any  man  to  graduate  in  his  class  who  failed 
to  suggest  examination  of  the  prostate  in  answer  to  the 
following  question:  "What  would  you  do  if  a  man  pre- 
sented himself  with  an  obscure  nervous  disease  ?"  At  the 
time  I  considered  the  statement  absurd — especially  as  the 
lecturer  was  not  a  Jefferson  professor — but  I  have  since 
often  thought  it  a  very  wise  utterance. 

Genito-urinary  diseases  of  men  as  result  of  prostatitis 
and  the  various  functional  nervous  disorders  related  there^ 
to,  whether  as  cause  or  effect,  are  in  the  same  condition 
that  diseases  of  women  were  in  fifty  years  ago.  At  that 
time  the  nervous  symptoms  that  accompanied  such  dis- 
orders in  females  as  lacerations  of  the  cervix  or  perineum, 
congestion  and  displacement  of  the  uterus  and  ovaries,  were 
succinctly,  if  unscientifically,  grouped  under  the  head  of 
hysteria,  and  these  symptoms  treated  without  reference  to 
the  cause  and  often  without  the  least  effort  to  arrive  at  a 
correct  diagnosis.  And  today  the  nervous  maladies  result- 
ing from  a  morbid  condition  of  the  prostate  gland,  such  as 
mental  depression,  morbid  fears,  nervous  dyspepsia,  pal- 
pitation, deficient  mental  control,  headache  and  backache, 
are  generally  dismissed  in  the  same  easy  fashion  to  the 
category  of  hypochondriasis. 

Considering  the  immense  importance  of  the  problem  in- 
volved in  the  relation  of  the  genital  function  to  the  nerv- 
ous system,  and  the  vast  amount  of  suffering  entailed  upon 
mankind  by  the  igcorance  of  the  patient  and  the  indiffer- 
ence of  the  physician  in  regard  to  these  problems,  remark- 
ably little  effort  has  been  expended  in  their  solution. 
Whether  there  is  or  is  not  such  a  disease  as  spermatorrhea, 
and  if  there  is,  what  is  its  nature  and  effect ;  when  are  in- 
voluntary  emissions  pathological-   what  are  the  various 


154  PROSTATE  GLAND  AND  ADNEXA. 

kinds  of  impotence,  and  liow  should  they  be  treated;  how 
are  morbid  conditions  of  the  prostate  gland  and  urethra 
reflected  to  the  nervous  system ;  how  do  nervous  and  other 
diseases  affect  the  genital  functions? — ^these  and  other 
problems  of  great  practical  interest  have  only  within  very 
recent  years  begun  to  attract  the  attention  of  the  inves- 
tigator, while  the  profession  at  large  are  as  yet  almost  blind 
as  to  their  importance. 

While  the  excitant  cause  of  sexual  neurasthenia  is  trace- 
able in  the  majority  of  instances  to  disease  of  the  prostate, 
yet  there  are  other  exacerbating  etiological  factors  that 
should  be  taken  into  consideration.  Prominent  among 
these  are  excessive  cigarette  smoking,  alcoholic  stimulants, 
business  cares,  domestic  worries  and  climatic  conditions. 
All  these  have  to  be  taken  into  account  as  concomitant  fac- 
tors in  genital  neuroses. 

The  symptoms  of  sexual  neurasthenia  are  so  protean  in- 
nature,  that,  according  to  the  prominence  of  one  or  other 
stage  of  its  development,  it  is  frequently  diagnosticated  as 
oxaluria,  lithemia,  or  disease  of  the  imagination. 

Its  real  and  tangible  cause  is  either  overlooked,  or  an 
attempt  to  discover  its  source  neglected.  The  physician  is 
usually  content  to  guess  at  the  cause,  prescribe  some  in- 
noxious remedy  and  await  the  result.  Others  resort  to  nux 
vomica  or  its  alkaloid,  combining  or  alternating  it  with 
various  other  aphrodisiacs,  which  serve  to  excite  an  already 
tender  or  diseased  prostate.  The  man  returns  from  time 
to  time  and  reports  some  better,  then  worse ;  when,  in  fact, 
he  is  growing  gradually  worse  all  the  time.  This  condition 
may  continue  for  a  long  time,  until  the  man  finally  be- 
comes aware  of  a  twitching  of  the  muscles  of  the  lower 
limbs;  in  others  the  fingers  tingle  or  there  is  an  impair- 
ment in  the  use  of  an  arm,  noticeable  in  writing  or  hand- 
ling a  knife  or  fork  while  eating.     In  others,  the  lower 


NEUROSES   OF    THE   PROSTATE.  155 

limbs  feel  heavy  or  numb^  requiring  an  effort  to  raise 
them  in  walking. 

Many  men  begin  with  pains  in  their  back,  which  extend 
over  their  hips,  down  to  the  calves  of  the  legs.  The  latter 
is  a  very  common  symptom,  owing  to  the  close  relation  of 
the  sciatic  plexus  to  that  of  the  prostatic  plexus  and  asso- 
ciate ganglia. 

Melancholia  is  a  very  common  sequel  of  prostatic  dis- 
ease, and  it,  just  as  other  neuroses  resulting  from  disease 
of  the  gland,  assumes  a  periodicity  at  first;  subsequently 
it  may  become  continuous.  I  have  clinically  observed  in 
men  suffering  from  prostatic  neuroses  that  the  periodicity 
is  markedly  analogous  to  the  menstrual  epoch  of  women, 
in  that  it  first  appears  in  paroxysms  of  about  four-week  in- 
tervals; and,  as  the  disease  becomes  more  aggravated,  it 
assumes  a  periodicity  of  two  weeks ;  when,  as  the  gravity  of 
the  disease  becomes  serious,  it  is  daily  or  continuous.  I 
would  advise,  in  these  obscure  nervous  diseases,  or  even 
in  any  chronic  condition,  where  a  monthly  exacerbation 
appears,  the  examination  of  the  prostate.  In  some  cases 
the  periodicity  is  manifested  in  bouts  of  drinking. 

It  may  seem  absurd  to  some;  and,  if  on  examining  the 
gland  it  is  found  to  be  healthy,  there  is  no  harm  done; 
when  you  can  then  dismiss  it  as  being  the  most  probable 
etiological  factor. 

Clinical  observation  has  demonstrated  that  young  men 
suffering  from  prostatitis  of  the  sub-acute  form,  are  more 
subject  to  paraparesis;  while  middle  aged  and  old  men 
affected  with  congested  enlargement  of  the  gland  are  more 
subject  to  hemiparesis.  "While  this  is  not  an  invariable  rule, 
yet  in  the  very,  large  majority  of  cases,  if  the  prostate  is 
examined  in  these  paralytic  diseases,  it  will  be  found  to  be 
diseased.  Melancholia  and  mania  may  follow  either  char- 
acter of  the  disease,  but  it  is  rare  in  senile  hypertrophy. 


156  PROSTATE  GLAND  AND  ADNEXA. 

The  innumerable  symptoms  that  result  from  reflex  ir- 
ritation of  the  prostate  are  brought  about  by  the  sympa- 
thetic system  or  vaso-motor  nerves  as  well  as  by  those  of 
the  cerebro-spinal  system.  The  more  highly  developed  the 
nervous  system  of  the  individual,  the  wider  the  effect  pro- 
duced by  the  shock  of  any  disease  of  the  gland.  But  in 
the  spreading  of  the  effect,  the  intensity  at  any  given 
point  is  diminished.  This  furnished  the  explanation  of  the 
seeming  paradox  that  strong  constitutions  are.  more  liable 
to  severe  local  disease  than  are  neurasthenics.  The  mole- 
cular changes  produced  by  disease  meet  with  far  less  re- 
sistance in  highly  involved  organizations  which  are  good 
conductors  of  every  kind  of  motion,  while  the  resistance 
offered  by  a  strong  constitution  tends  to  produce  local 
functional  disease.  Thus  it  is  that  functional  excesses  in 
the  strong  tend  to  produce  excessive  functional  nervous 
diseases. 

The  same  fact  serves  to  explain  another  apparent  para- 
dox, that  nervous  hysterical  patients,  who  run  the  gamut  of 
nervous  disorders  every  day  of  their  lives,  are  frequently 
long  lived ;  disease,  as  it  were,  proving  an  antidote  to  dis- 
ease. The  destructive  force  of  disease  which  meets  with 
vigorous  resistance  in  a  strong  body,  concentrates  itself 
locally  with  lethal  violence,  while  in  the  weak,  nervous 
constitution,  it  is  conducted  away,  attenuated  and  rendered 
comparatively  innocuous. 

MELANCHOLIC  MANIA. 

This  is  one  of  the  most  distressing  as  well  as  varied  in 
its  manifestations  of  any  of  the  neurotic  diseases  follow- 
ing prostatitis.  Among  the  incidents  of  most  every  phy- 
sician, long  in  practice,  the  proverbial  phrase  that  "It  never 
rains  but  it  pours''  has  been  tangibly  presented  at 
some  time  of  his  professional  career.     It  fell  to  my  lot 


NEUROSES   OF   THE  PROSTATE.  157 

some  years  ago  to  have  had  quite  a  number  of  these  cases 
of  melancholia  following  in  close  order  to  one  another. 

Case  XXVIII.    Chkonic  Prostatitis  and  IIelaxcholic 

Mania. 

Merchant;    aged    forty-four;    very    emaciated,    though 
strong  and  an  active  business  man.     For  two  years  he  had 
suffered  with  occasional  attacks  of  nervous  depression  fol- 
lowed by  hot,  alternating  with  cold,  flashes.    These  "spells" 
as  he  termed  them,  had  gradually  grown  more  frequent 
and  aggravated.     At  first  they  would  occur  every  three 
months,  then  monthly,  and  finally  every  two  weeks.     His 
temperature  would  never  rise  more  than  one-half  degree, 
even  when  he  said  he  felt  as  though  he  was  burning  up. 
I  inquired  as  to  the  condition  of  his  kidneys,  bladder  and 
sexual  organs.     He  was  very  reticent  regarding  them  and 
at  first  strenuously  objected  to  an  examination.     Finally 
upon  submitting  to  an  examination,  the  prostate  was  found 
to  be  exceedingly  sensitive  and  slightly  swollen.     It  was 
so  sensitive  that  he  refused  to  have  it  treated.     He  con- 
tinued to  grow  worse  until  he  was  advised  by  his  wife  and 
friends  to  take  a  rest.    He  went  to  a  country  town  and  en- 
gaged rooms  at  a  hotel.    He  had  been  there  just  about  ten 
days  when  he  had  "one  of  his  spells."     His  wife  sent  for 
a  phj'sician,   who,  after  having  examined  the  man,  pre- 
scribed some  innocuous  remedy  and  left.     After  having 
taken  one  dose  of  the  medicine,  the  man  conceived  the  idea 
that  his  wife  had  connived  with  the  doctor  to  poison  him 
for  the  purpose  of  procuring  his  money.     He  violently  op- 
posed taking  another  dose  of  the  medicine,  to  avoid  which, 
having  been  persuasively  urged  to  do  so,  he  leaped  from  his 
bed  and  ran  out  of  his  room  in  his  night  clothes  down 
the   stairs   from  the   sixth  floor   to   the   oflice,   screaming 
"murder."     He  maintained  that  I,  onlv,  knew  his  constitu- 


158  PROSTATE  GLAND  AND  ADNEXA. 

tion  and  was  capable  of  prescribing  for  him.  He  had  his 
wife  wire  me  to  come  and  see  him  (some  two  hundred 
miles  distant) .  Several  telegrams  were  sent  daily  for  three 
days,  when  I  finally  decided  to  go.  On  my  arrival  at  noon, 
and  making  myself  known  to  the  clerk  at  the  hotel,  he 
said  that  my  patient  was  in  the  dining  room,  across  from 
the  office,  and  for  me  to  walk  in  and  get  my  dinner.  I  was 
cordially  greeted  by  both  man  and  wife,  who  requested 
me  to  order  my  dinner.  Questions  were  immediately  pro- 
pounded by  the  man  regarding  incidents  at  home,  evidently, 
as  I  understood,  to  avoid  mention  of  his  health.  He  was 
quite  cheerful,  apparently,  and  discussed  different  sub- 
jects intelligently.  The  subject  of  his  health  was  not  men- 
tioned until  on  leaving  the  dining  room,  he  requested  me 
to  go  with  him  to  the  parlor,  where  he  narrated  the  inci- 
dents before  mentioned,  in  a  very  quiet  and  rational  man- 
ner, explaining  his  reasons  therefore.  He  stated  that  he 
had  had  "one  of  his  spells,"  and  that  the  first  dose  of 
medicine  was  poison,  and  that  he  had  acted  in  that  way 
to  attract  the  attention  of  the  police,  that  they  might  arrest 
and  lock  him  up  until  I  could  arrive  to  treat  him.  I  re- 
mained with  him  several  hours  and  left  him  in  the  best  of 
spirits;  he  consenting  to  remain  there  several  weeks  until 
he  regained  his  health.  On  the  following  morning  I  heard 
that  he  had  returned  home  and  was  violently  insane.  He 
was  arrested  by  the  police  and  incarcerated.  He  sent 
for  an  attorney,  to  whom  he  explained  that  he  had  been 
arrested  and  imprisoned  for  sinister  purposes.  He  was 
released,  as  he  was  as  rational,  apparently,  as  any  one. 
In  a  few  days  thereafter  he  again  became  violent  and 
was  placed  in  custody  at  his  home.  During  these  at- 
tacks he  would  suffer  with  continuous  priapism  both  day 
and  night.  During  the  rational  intervals  he  would  be 
comparatively    free    from    the    annoying    erections.      He 


NEUROSES   OF   THE  PROSTATE.  159 

was    carried  to  the    asylum  in  this  state,  where  he  re- 
mained a  few  months  and  died. 

Case  XXIX.    Insomnia,  Melancholia,  Prostatitis. 

Clerk;  aged  thirty-eight;  married.  Very  large  and  ap- 
parently in  robust  health.  I  was  called  in  consultation 
to  see  the  man,  when  the  attending  physician  gave  the 
following  history :  The  patient  had  never  had  any  ven- 
ereal disease,  but  had  been  addicted  to  excessive  venery 
in  early  youth,  and,  at  times,  until  within  the  past  two 
years.  He  has  paroxysmal  periods  of  excessive  sexual 
desires.  One  sexual  congress  seemed  to  intensify  the 
propensity  for  a  second  or  third  in  rapid  succession.  This 
would  last  for  three  or  four  da3'S,  when  he  would  lapse 
into  a  state  of  melancholy  and  insomnia.  He  had  first 
noticed  the  attacks  monthly,  attended  with  only  slight 
depression  of  spirits;  but  for  six  months  prior  hereto  he 
would  be  scarcely  relieved  of  one  attack  before  the  recur- 
rence of  a  second.  He  would  not  average  more  than  five 
hours'  sleep  during  the  twenty-four,  and  only  then  under 
the  influence  of  a  narcotic.  There  were  few  symptoms 
indicating  prostatic  trouble.  The  urine  was  voided  more 
frequently  than  normal  at  times,  and  contained  an  ex- 
cessive quantity  of  phosphates  and  some  uric  acid. 

I  advised  an  examination  of  the  prostate;  this  was  op- 
posed by  the  patient  and  not  encouraged  by  the  attending 
physician.  I  did  not  hear  from  the  patient  again  for  six 
months,  when  I  was  again  called  to  see  him  with  his  phy- 
sician. He  had  grown  steadily  worse  and,  though  taking 
from  sixty  to  eighty  grains  of  sulphonal  daily,  he  was 
sleeping  not  more  than  three  hours  during  the  twenty- 
four.  He  had  developed  a  religious  mania  and  was  sing- 
ing and  praying  much  of  his  time.  He  had  now  become 
totally  impotent.     I  again  insisted  upon  an  examination 


160  PROSTATE  GLAND  AND  ADNBXA. 

of  the  genital  organs,  which  revealed  both  chronic  pros- 
tatitis and  vesiculitis.  Immediate  improvement  followed 
treatment  of  the  gland  and  vesicles,  and  today  he  is  a 
healthy,  active  business  man. 

I  could  report  several  other  similar  cases  with  various 
complications  that  have  come  under  my  observation,  where 
relief  of  the  prostate  and  vesicles  was  followed  by  com- 
plete recovery  of  all  other  nervous  symptoms. 

The  perversion  of  the  sexual  organs,  as  cause  of  lunacy, 
gave  rise  to  the  advocacy  and  practice,  in  some  of  our  asj^- 
lums  a  few  years  ago,  of  castration  for  its  relief. 

Melancholia  as  a  result  of  prostatitis  does  not  always 
develop  insanity.  I  have  noted  its  manifestations  in  the 
most  varied  phases  of  hysteria,  mental  and  physical  weak- 
ness, obstinate  pessimism,  and  occasionally  extreme  op- 
timism. 

One  hysterical  patient  that  I  can  recall  would  lie  down 
upon  the  floor  and  roll  over  and  cry  for  a  time  and  then 
laugh.  He  was  forty-four  years  old,  married,  had  three 
children,  and  never  had  gonorrhea.  His  prostate  was  so 
tender  that  he  fainted  when  it  was  gently  touched.  He 
recovered  entirely  from  his  nervous  sj^mptoms  after  the 
relief  of  the  prostatic  trouble.  These  cases  all  have  an 
exceedingly  sensitive  urethra,  even  those  that  never  had 
gonorrhea. 

Dyspepsia  and  constipation  are  common  sequels  of  pros- 
tatitis, often,  too,  when  there  are  no  indications  of  dis- 
ease of  the  gland.  I  recall  one  case  that  was  brought  to 
me  by  a  former  patient  who  had  suffered  with  indigestion 
and  flatulency  for  several  years.  During  this  time  he 
had  consulted  many  physicians  and  had  taken  all  the  indi- 
gestion remedies  advised  by  both  physicians  and  drug- 
gists. He  was  existing  solely  upon  milk  and  some  form 
of  Battle  Creek  food.     There  was  not  an  objective  symp- 


NEUROSES   OF   THE  PROSTATE.  163 

torn  pointing  to  any  form  of  disease  of  the  gland,  and 
I  hesitated  very  much  to  suggest  an  examination  of  it. 
He  readily  submitted  to  an  examination,  to  my  surprise, 
wlien  I  found  the  gland  slightly  affected.  I  had  him  dis- 
continue the  use  of  medicines  and  eat  sparingly  for  a 
few  weeks.  I  treated  the  gland  through  the  urethra  and 
rectum  on  alternate  days  and  did  not  give  him  a  single 
dose  of  medicine.  He  fully  recovered  and  gained  twenty 
pounds  in  weight  within  two  months  and  has  never  had 
a  symptom  of  his  former  trouble  since,  though  he  eats 
anything  he  wishes. 

Other  cases  of  indigestion,  with  pronounced  symptoms 
of  disease  of  the  gland,  have  been  quite  common. 

Sciatica  or  affections  of  some  of  the  branches  of  the 
sciatic  nerve  are  common  sequels  of  prostatitis. 

Fig.  XXII.  illustrates  the  nerve  and  some  of  its  branches. 
Those  distributed  to  the  muscles  of  the  calf  of  the  leg  are 
more  frequently  affected,  even  when  the  great  sciatic  es- 
capes. I  recall  one  man  fifty-two  years  old,  who  had 
sharp,  darting  pains  in  the  calves  of  his  legs,  and,  at 
times,  in  the  thigh.  He  had  been  treated  with  "goat 
lymph"  and  otherwise  for  locomotor  ataxia  several  years. 
His  prostate  was  exceedingly  sensitive.  After  the  third 
treatment  of  the  gland  his  pains  disappeared  and  never 
returned. 

I  have  seen  several  cases  who  had  pain  only  in  the  heel. 
One  of  these  had  been  suffering  intensely  for  about  a 
week,  both  day  and  night.  He  never  had  gonorrhea,  nor 
had  he  any  prominent  symptoms  of  prostatitis.  The  pain 
immediately  disappeared  after  the  first  treatment  of  the 
gland.  It  returned  some  days  afterward,  but  finally  left 
him  entirely,  after  the  gland  had  been  relieved. 


162  PROSTATE  GLAND  AND  ADNEXA. 


Fig.  XXII.     (Gray.) 


NEUROSES   OF   THE   PROSTATE.  163 

Case  XXX.    Sciatica,  Prostatitis,  Spermatorrhea. 

Clerk;  aged  twenty-six;  single.  He  had  gonorrhea  of 
a  severe  type  when  twenty-one,  which  was  long  continued. 
He  thought  that  he  had  never  fully  recovered  from  the 
attack.  Some  two  years  after  the  prime  inception  of  the 
disease,  he  noticed  a  continuous  oozing  from  the  penis, 
vital  depression  and  impaired  function  and  erections. 
Subsequently  pain  in  the  back  and  left  hip  developed. 
It  grew  worse  when  sitting  for  a  long  time.  Exercise  re- 
lieved the  pain  for  the  time.  He  would  pass  several  weeks 
frequently  without  noticing  any  special  inconvenience, 
when,  suddenly,  he  could  scarcely  arise  from  his  chair. 
The  attacks  became  insidiously  more  severe  from  month  to 
month,  until  he  had  a  severe  paroxysm  that  confined  him 
to  bed  for  six  weeks.  During  this  time  he  sufEered  in- 
tensely, necessitating  the  use  of  large  doses  of  opium  for 
relief.  The  muscles  along  the  course  of  the  sciatic  nerve 
became  very  much  atrophied,  leaving  a  depression  in  the 
limb.  He  had  taken  almost  every  conceivable  remedy, 
together  with  a  course  of  baths  at  Hot  Springs,  Arkansas, 
which  only  gave  temporary  relief.  The  direct  static  spark 
over  the  spine  and  along  the  course  of  the  nerve  gave 
the  most  relief,  for  the  time. 

Upon  examination  I  discovered  a  slight  stricture  in  the 
membranous  urethra,  chronic  prostatitis  and  vesiculitis. 

The  sciatic  pain  was  permanently  relieved  soon  after 
beginning  treatment  of  the  gland.  Massage  of  the  limb 
restored  it  to  its  normal  size. 

IMPOTENCY. 

Impotence  may  exist  in  a  modified  degree,  or  amount  to 
total  functional  incapacity.     There  may  be  only  a  defi- 


164  PROSTATE  GLAND  AND  ADNEXA. 

ciency  of  erectile  power,  or  desire  and  capacity  may  both 
be  lacking.  Or,  again,  erectile  power  may  be  normal  at 
times,  when  free  from  erotic  excitement,  and  then  be- 
come flaccid  and  useless  in  the  presence  of  women.  Some- 
times an  erection  takes  place  at  the  proper  time,  but  it 
does  not  last  sufficiently  long  for  intromission,  much  to 
the  disgust  and  chagrin  of  the  man.  Sometimes  prema- 
ture ejaculation  occurs,  but  often  no  emission  takes  place. 

I  shall  not  attempt  here  a  discussion  of  the  mechanism 
of  erection,  but  it  is  chiefly  under  the  influence  of  the  ner- 
vous system,  which  is  controlled  mainly  through  the  "sex- 
ual brain"  as  situated  in  the  prostate,  or,  as  many  think, 
in  the  caput  gallinaginis.  There  is  no  paralysis  or  loss 
of  power  in  the  muscular  or  vascular  conditions  of  the 
organ  that  affect  the  mechanical  part  of  the  erection. 

Failure  to  perform  the  act,  at  some  one  time,  often  be- 
comes so  impressed  upon  the  mind  of  the  man  that  even 
after  the  restoration  of  the  prostate  to  its  normal  condi- 
tion, it  requires  several  efforts  to  restore  confidence. 

I  recall  the  case  of  a  libertine,  who,  suffering  from 
prostatitis,  had  made  repeated  failures  with  his  mistress, 
and  after  having  been  restored,  would  still  fail  with  her, 
yet  complete  the  act  perfectly  with  other  women. 

There  is  often  diminished  sensibility  of  the  penis  and 
scrotum,  which  appear  also  cold  and  lifeless. 

Impotency  due  to  disease  of  the  prostate  and  vesicles 
is  almost  invariably  attended  with  seminal  loss  in  some 
form;  that  is,  in  young  or  middle  aged  men.  The  terms 
in  general  use  for  unnatural  seminal  discharges  are  some- 
what confusing,  as  they  are  often  used  synonymously. 
Those  to  which  I  adhere  are  nocturnal  or  involuntary  sem- 
inal discharges,  pollutions  and  spermatorrhea. 

The  first  occurs  in  one's  sleep  and  is  attended  with  an 
orgasm  that  generally  arouses  him.     Pollutions  may  take 


NEUROSES  OF   THE  PROSTATE.  165 

place  at  any  time,  but  more  frequently  during  sleep,  and 
emissions  occur  in  a  similar  way  to  the  former,  but  in  a 
passive  form,  and  not  attended  with  an  orgasm,  which 
rarely  arouses  one  from  sleep. 

Spermatorrhea  takes  place  in  a  slow,  dribbling  man- 
ner, without  erection  or  orgasm.  It  produces  the  sensa- 
tion as  though  something  was  running  from  the  penis. 
The  latter  may  be  concomitant  with  either  of  the  acute 
forms.  Moreover,  it  is  often  the  case  that  prostatorrhea 
only  exists,  which  is  mistaken  for  spermatorrhea. 

Kervous  depression  or  moodiness  is  not  usually  due  to 
the  loss  of  semen,  even  when  seminal  discharges  are  promi- 
nent, but  to  the  incessant  reflex  nervous  irritation  to  the 
cerebro-spinal  centers  as  result  of  the  diseased  gland. 
Should  an  emission  occur  when  asleep,  and  not  oftener 
than  ten  days  or  two  weeks,  in  a  man  of  vigorous  habits, 
it  should  not  be  considered  pathological,  when  the  man 
had  abstained  from  all  sexual  relations  during  that  time. 
Ultzman  and  S.  W.  Gross  concur  in  this  view. 

I  cannot  impress  too  forcibly  the  importance  of  an  ex- 
amination of  the  gland  in  these  obscure  cases,  as  I  know 
too  well  that  physicians  are  prone  to  neglect  such,  and 
yield  too  readily  to  an  obduracy  upon  the  part  of  the  pa- 
tient to  submit  to  an  examination  because  of  over  prudery, 
or  that  it  suggests  venereal  disease. 

I  can  recall  several  suicides  of  prominent  business  men, 
who,  if  their  prostatic  conditions  had  been  properly  diag- 
nosed and  relieved,  could  have  been  saved  an  untimely 
death. 

Men  suffering  from  melancholia,  as  a  result  of  pros- 
tatitis, are  much  more  able  to  resist  the  evil  effects  of  the 
disease  when  employed  than  when  idle.  It  is  very  unwise 
to  advise  such  men  to  go  away  for  a  rest.  I  have  known 
of  several  instances  where  men  were  so  advised,  and  who, 


166  PROSTATE  GLAND  AND  ADNEXA. 

having  no  other  mental  employment  than  to  brood  over 
their  ailments,  became  maniacal  or  suicidal. 

The  simple  knowledge  of  impotency  so  preys  upon  the 
minds  of  some  men  as  to  aggravate  their  physical  and 
mental  condition,  impair  their  digestion,  disturb  their 
sleep  and  wreck  their  health. 

STERILITY. 

Potentia  coeundi  does  not  always  imply  potentia  gen- 
erandi.  The  latter  depends  entirely  upon  the  procreative 
power  of  the  semen,  while  the  former  implies  the  ability 
of  the  man  to  complete  the  act  of  coitus. 

It  is  a  well-known  physiological  fact  that  healthy  pros- 
tatic fluid  is  essential  to  perpetuate  the  lives  of  the  sper- 
matic germs  until  they  reach  their  destination  of  impreg- 
nating the  ovum.  The  vesicles,  too,  are  important  factors 
towards  maintaining  the  vitality  of  these  germs.  The 
prostate  and  vesicles  are  in  such  close  proximity  and  so 
allied  in  their  physiological  relations,  that  disease  of  one 
readily  extends  and  involves  the  other. 

It  is  not  infrequently  the  case  that  men  are  able  to 
complete  the  act  of  coitus,  yet  the  spermatozoa  may  be 
lifeless  or  so  impaired  in  vitality  from  perverted  prostatic 
secretions  as  to  render  them  sterile.  The  wives  of  such 
men  are  too  often  subjected  to  all  kinds  of  treatment  and 
operations  for  barrenness,  when  the  fault  lies  with  the 
men.  Several  cases  of  this  kind  have  come  under  my  care, 
where  relief  of  the  prostate  was  followed  by  fruitful  re- 
sults, 

PEOSTATOREHEA. 

Ultzmann  says:  "With  every  sexual  excitement  as 
soon  as  erection  of  the  penis  has  occurred,  long  before 
ejaculation  of  semen  has  taken  place,  a  clear,  transparent, 


NEUROSES  OF   THE  PROSTATE  167 

viscid  drop,  like  white  of  egg,  oozes  from  the  meatus. 
This  clear,  viscid  drop  represents  the  secretion  of  the  ac- 
cessory glands  of  the  urinary  and  genital  tracts  and  con- 
sists of  the  secretions  of  the  prostate,  of  Cowper's  glands 
and  the  glands  of  Littre.  Since  the  prostate  is  the  largest 
gland  in  this  connection,  it  is  evident  that  the  mass  of 
this  fluid  must  be  the  prostatic  secretion.  If  this  clear, 
viscid  fluid  is  secreted  in  greater  amount,  indeed  continu- 
ally and  without  sexual  excitement,  this  condition  is  called 
prostatorrhea." 

The  fact  is  that  the  normal  viscid  secretion  attending 
sexual  excitement  and  erections,  is  often  mistaken  for  a 
pathologic  state,  when  it  really  indicates  a  healthy  con- 
dition of  the  gland  and  is  premonitory  to  a  seminal  ejec- 
tion. This  prostatic  secretion  serves  to  lubricate  the  chan- 
nels and  favor  the  passage  of  semen,  besides  its  aid  in 
maintaining  the  lives  of  the  spermatozoa. 

Prostatorrhea  is  due  to  an  inflamed  condition  of  the 
gland  as  a  result  of  gonorrhea,  masturbation  or  other  sex- 
ual excitements.  Prostatic  calculi  or  rectal  diseases  may 
serve  as  exciting  causes,  but  they  are  more  frequently  the 
effect  and  not  the  cause  of  the  trouble. 

The  differential  diagnosis  between  prostatorrhea  and 
spermatorrhea  depends  largely  upon  microscopic  exami- 
nation of  the  secretion.  The  presence  in  the  secretion  of 
Bottcher's  crystals  and  amyloid  bodies  would  point  strongly 
to  prostatorrhea,  while  the  presence  of  spermatozoa  would 
not  exclude  that  condition  as  a  possibility,  as  spermator- 
rhea often  accompanies  prostatorrhea,  though  the  latter  is 
much  more  common. 

Azoospermia  is  a  common  sequel  of  prostatitis  and  vesic- 
ulitis, as  the  perverted  secretions  of  these  organs  tend  to 
devitalize  and  destroy  the  spermatic  germs  and  render  the 
man  sterile. 


168  PROSTATE  GLAND  AND  ADNEXA. 

The  urine  in  these  cases  is  variable  in  quantity,  and  is 
usually  of  light  color,  containing  small  shreds  or  hook- 
shaped  flakes. 

TREATMENT. 

Successful  treatment  of  these  conditions  depends  upon 
proper  diagnosis  and  the  removal  of  the  cause.  As  the 
etiological  factors  are  almost  invariably  traceable  to  the 
diseased  prostate  and  vesicles,  these  organs  must  neces- 
sarily be  relieved  before  any  permanent  benefit  can  be 
procured.  As  the  .treatment  has  been  discussed  in  previ- 
ous chapters,  the  reader  is  referred  thereto  for  full  details. 

There  are  some  cases,  however,  of  long  standing  disease 
of  the  prostate  where,  even  after  the  gland  had  been  cured. 


Fig.   XXIII. 


there  remain?  an  impaired  function  of  the  genitalia,  due 
to  lack  of  nervous  energy.  For  relief  of  this  condition  I 
have  devised  a  bipolar  rectal  electrode.  Fig.  XXIII. 

Fig.  XXIV.  shows  the  application  of  this  electrode,  oiie 
pole  being  directed  to  the  prostate  in  front  and  the  other 
to  the  sacral  and  hypogastric  plexuses  of  nerves  that  min- 
ister to  the  pelvic  organs.  By  passing  the  electrode  fur- 
ther up  the  rectum  the  poles  are  in  apposition  to  the  vesi- 
cles in  front  and  the  genito-spinal  center  jDosteriorly.  I 
have  found  this  treatment  very  efficient  in  such  cases. 

It  is  a  common  practice  among  physicians  of  giving 
aphrodisiacs  in  these  cases,  without  attempting  to  ferret 
out  the  cause  of  the  trouble,  which  serves  to  aggravate 
an  already  serious  condition.  I  was  surprised  to  note  that 
the  distinguished  Dr.  Ultzman   (professor  of  genito-uri- 


NEUROSES   OF   THE  PROSTATE.  169 

nary  diseases  in  the  University  of  Vienna)  advises  the 
stroking  of  the  external  genital  organs  with  electricity  for 
impotency,  yet  further  states  (page  41)  :  "This  method 
of  treating  impotence  is  not  infrequently  accompanied  by 
the  most  excellent  results,  only  it  has  its  shady  side,  and 


Fig.    XXIV. 

that  is  that  nocturnal  emissions  are  promoted,  i.  e.,  in- 
creased." 

Impotency,  which  is  most  often  the  result  of  prostatitis, 
should  never  be  treated  by  exciting  the  genital  organs 
either  with  medicines  or  electricity,  until  the  diseased  con- 
dition of  the  gland  is  relieved,  when,  in  the  large  majority 


170  PROSTATE  GLAND  AND  ADNEXA. 

of  cashes,  the  normal  function  is  restored  without  the  use 
of  any  exciting  agents. 

There  are  some  cases^  however,  in  whom  stimulating 
aphrodisiacs  arouse  transient  genital  activity  which  is 
usually  followed  by  total  impotence  and  seminal  losses. 

Prostatic  Facies. — Just  as  Kelly  describes  an  ovarian 
face  in  women,  there  is  an  analogous  expression  in  most 
all  men  suffering  from  chronic  prostatitis.  It  is  quite 
noticeable  in  many  men,  which  readily  disappears  upon 
restoring  the  gland  to  its  normal  condition. 

Glycosuria  and  albumen  often  appear  in  minute  quan- 
tities where  neurotic  symptoms  are  prominent;  but  they 
are  of  transient  nature  and  readily  disappear  as  soon  as 
the  local  trouble  is  relieved.  Neither  of  these  conditions 
implies  disease  of  the  kidney.  Since  Claude  Bernard 
demonstrated  that  puncturing  the  floor  of  the  fourth  ven- 
tricle would  produce  albuminuria  or  glycosuria,  it  is  now 
a  Veil  known  fact  that  many  nervous  shocks  cause  them 
to  temporarily  appear. 

Imaginary  Impotency. — Much  has  been  written  and 
spoken  of  impotence  existing  only  in  the  head.  Many  of 
these  expressed  opinions  have  originated  from  some  of 
the  most  prominent  surgeons  and  genito-urinary  special- 
ists, who  had  either  failed  to  locate  the  cause  of  the 
trouble  or  to  relieve  it  after  having  discovered  the  source. 
But  very  few  of  these  cases  are  really  imaginary. 

Case  XXXI. 

Aged  thirty-two;  single.  Never  had  gonorrhea.  He 
had  been  addicted  to  sexual  abuses  followed  by  frequent 
emissions  and  chronic  discharge.  The  first  physician 
treated  him  with  tonics,  or  constitutionally;  the  second 
with  sounds ;  the  third  with  both.  After  having  gone  the 
rounds  for  six  years,  trying  to  get  in  shape  to  marry,  he 


NEUROSES   OF   THE  PROSTATE.  171 

was  advised  to  do  so^  and  that  he  would  then  become 
normal.  The  trouble  continued.  Two  years  after  his 
marriage  he  came  to  me  for  treatment.  I  discovered  an 
inflamed  prostate  and  urethra.  Normal  functions  re- 
turned just  as  soon  as  these  organs  were  relieved,  and 
without  taking  a  dose  of  constitutional  medicine. 

Case  XXXII. 

x4.ged  twenty-eight;  strong  and  robust  in  appearance. 
He  was  not  sure  whether  he  had  ever  had  gonorrhea  or  not, 
as  some  physicians  had  told  him  he  had,  and  others  that 
he  had  not.  He  was  annoyed  with  excessive  pollutions. 
Different  physicians  advised  him  to  marry  and  that  his 
trouble  was  in  his  head  alone.  He  recovered  his  sexual 
powers  when  relief  of  his  prostate  was  effected. 

PARAPAEESIS. 

This  condition  especially  calls  for  a  thorough  exami- 
nation of  the  prostate  gland  and  adnexa.  For  the  past 
fifteen  years,  since  I  have  had  my  attention  more  espe- 
cially directed  to  the  prostate  as  an  etiological  factor  in 
this  trouble,  I  have  not  seen  a  single  case  of  paraparesis 
or  impaired  function  of  the  lower  limbs  where  the  gland 
was  not  involved,  unless  due  to  syphilis  or  lesion  of  the 
spine.  This  condition  occurs  more  often  in  young  men 
who  have  been  subject  to  excessive  masturbation  or  sexual 
indulgence. 

The  onset  of  the  trouble  is  usually  manifested  by  a 
sensation  of  heaviness  or  weight  about  the  lower  limbs, 
which,  as  the  disease  progresses,  becomes  so  marked  as  to 
interfere  in  climbing  stairs.  Tliere  is  rarely  any  pain  in 
these  cases  at  first;  and  should  it  supervene  at  all,  it  is 
usually  manifested  by  a  few  darting  pains  in  some  of  the 
branches  of  the  sciatic  nerve,  in  the  region  of  the  popliteal 
space  or  calf  of  the  leg. 


172  PROSTATE  GLAND  AND  ADNEXA. 

The  progress  is  usually  of  an  insidious  nature,  and 
especially  if  due  to  masturbation.  If  due  to  excessive 
sexual  indulgence  and  accompanied  with  a  bout  of  drink- 
ing, it  is  liable  to  be  sudden.  I  have  seen  cases  of  the 
latter  where  sudden  paraplegia  resulted.  In  rare  in- 
stances of  this  affection,  the  pains,  as  before  described,  have 
been  the  prominent  premonitory  symptoms.  Others  still 
have  described  sensations  as  though  something  was  creep- 
ing up  their  limbs. 

Case  XXXIII. 

I  recall  the  case  of  a  man,  twenty-eight  years  of  age, 
who  had  been  suffering  eighteen  months  with  paresis. 
There  was  no  pain  in  the  limbs,  but  the  impaired  function 
became  more  perceptible  from  week  to  week  until  there 
was  total  loss  of  power.  During  this  time  the  young  man 
had  been  treated  by  several  physicians,  some  of  whom  diag- 
nosed the  case  as  that  of  locomotor  ataxia.  Not  one  of 
them  suspected  the  prostate  as  the  cause  of  the  trouble,  or 
even  examined  it.  When  I  first  saw  him  he  had  no  more 
use  of  his  lower  limbs  than  if  they  were  made  of  rubber. 
I  found  him  totally  impotent,  with  a  persistent  prostator- 
rhea  and  occasionally  nocturnal  pollutions. 

I  directed  my  treatment  entirely  to  the  prostate,  when 
improvement  began  at  once.  In  six  weeks  time  he  could 
stand  upon  his  legs,  and  after  six  months  he  was  back  at 
work,  and  one  could  scarcely  detect  any  defect  in  his  gait. 

HEMIPAEESIS. 

This  trouble  is  very  common  among  older  men  suffering 
from  enlarged  inflammation  of  the  prostate.  The  first 
manifest  symptom  is  a  dragging  of  one  foot  in  walking, 
scraping  of  the  pavement.  This  is  often  noticeable  by  one's 
companion  before  the  person  himself  has  observed  it. 


NEUROSES   OF   THE   PROSTATE.  173 

Case  XXXIV. 

I  recall  one  case  who  said  the  first  time  he  had  his 
attention  called  to  any  defect  in  his  left  foot  was  by  his 
wife,  when  walking  upon  the  street,  when  she  said :  ''Will ! 
for  goodness  sake  quit  scraping  your  foot  on  the  pave- 
ment." He  had  never  noticed  it  before,  and  when  his 
attention  was  called  to  the  fact  he  went  along  for  some 
distance  without  doing  so  again ;  but  his  mind  being  with- 
drawn from  his  walking,  he  was  again  reminded  of  it  by 
his  wife.  When  dressing  the  next  morning  he  first  noticed 
that  the  sole  of  his  left  shoe  was  much  worn  out  at  the 
toe,  while  the  other  was  not.  From  that  time  on  he  no- 
ticed a  perceptible  impairment  of  his  left  side.  This  was 
followed  by  loss  of  co-ordination  in  writing. 

This  case  applied  to  me  for  treatment  eighteen  years 
ago.  I  did  not  know  as  much  about  the  cause  of  these 
troubles  then  as  now,  so  I  treated  his  spine  by  electricity, 
massage  and  mechanical  movements  for  several  months, 
which  gave  him  temporary  relief;  but  he  was  gradually 
growing  worse  from  month  to  month.  He  finally  men- 
tioned certain  symptoms  implicating  the  sexual  organs 
that  led  to  an  examination  of  the  prostate,  which  revealed 
the  seat  of  the  trouble.  Noticeable  improvement  followed 
the  treatment  of  the  gland  within  two  weeks  from  the 
time  of  its  beginning.  Three  months  thereafter  he  was 
able  to  resume  his  work  and  left  the  city.  I  did  not  see 
him  again  for  nine  months ;  when  upon  his  return  he  was 
so  far  well  that  his  defect  was  almost  imperceptible. 

Case  XXXV. 

Merchant;  aged  fifty-six;  married.  Up  to  his  fifty- 
third  year  he  had  been  quite  active.  About  that  time  he 
began  to  notice  that  he  would  scrape  his  right  foot  upon 


174  PROSTATE  GLAND  AND  ADNEXA. 

the  pavement  when  walking.  He  could  prevent  this  scrap- 
ing, at  first,  when  his  attention  was  directed  to  it;  but 
immediately  on  withdrawing  his  mind  from  the  sluggish 
foot,  the  scraping  of  the  pavement  would  recur.  He  next 
noticed  an  impairment  of  his  right  hand  when  attempting 
to  tie  a  bundle.  He  was  unable  to  grasp  a  string  sufTi- 
eiontly  tight  to  tie  a  knot.  This  condition  grew  worse,  l)y 
degrees,  until  he  could  not  use  his  knife  while  eating.  The 
leg  was  equally  impaired.  Both  hand  and  leg  began  to 
im.prove  after  the  second  week's  treatment  of  a  congested 
enlarged  prostate.  The  gain  was  steady  for  two  months; 
but  there  was  still  an  impaired  function.  I  then  began- 
the  application  of  the  bi-polar  electrode  as  illustrated 
(Fig.  XXIII.),  passing  the  current  through  the  prostate  in 
front,  and  the  sacral  plexus  and  lower  part  of  the  spinal 
cord' behind.     Marked  relief  followed  this  treatment. 

I  recall  another  similar  case  of  a  harness  maker,  whose 
right  hand  became  so  impaired  that  he  could  not  draw  a 
thread  in  stitching.  His  right  leg  was  also  impaired. 
After  being  treated  in  a  similar  way  to  the  foregoing  case 
for  six  weeks,  he  was  enabled  to  resume  his  work.  The 
treatment  was  continued  for  six  months,  at  irregular  in- 
tervals, when  he  fully  recovered. 


APPENDIX. 


CHAPTEE  YIII. 

ELECTRO-PHYSICS,    ELECTROLYSIS    AND    CATAPHORESIS. 

I  shall  treat  these  subjects  in  their  chemic,  physiolog- 
ical and  therapeutic  relations  only  in  so  far  as  they  pertain 
to  my  subject. 

Introduction. 

A  knowledge  of  the  construction  of  batteries  and  acces- 
sories, the  manner  of  producing  the  different  currents, 
together  with  their  various  modifications,  is  as  essential  to 
their  proper  understanding  and  scientific  applications  as 
is  that  of  chemistry,  physiology  and  anatomy  to  the  prac- 
tice of  medicine  and  surgery.  Anyone  capable  of  using 
these  potent  agents  in  a  scientific  and  practical  manner 
with  impunity  should  be  able  to  make,  or  have  constructed 
by  his  own  directions,  batteries,  accessories  and  electrodes 
to  meet  all  indications  that  arise.  I  have  known  of  fre- 
quent instances  where  physicians  were  using  the  galvanic 
current  who  did  not  know,  positively,  which  was  the  anode 
or  cathode,  yet  there  is  as  much  difference  in  their  effects 
as  that  of  calomel  and  opium.  Others  regard  the  sinu- 
soidal and  faradic  currents  as  the  same  or  similar  in  effect, 
when  their  properties  are  almost  as  different  as  that  of 
the  two  poles  of  the  galvanic. 

The  empirical  use  of  the  currents  is  not  confined  to  the 
country  physicians,  but  it  is  often  so  used  by  some  of  our 
leading  specialists,  and  so-called  professors  of  electro- 
therapeutics. 

175 


176  ELECTRO-PHYSICS. 

I  have  had  quite  a  number  of  physicians  consult  me  who 
had  diplomas  in  electro-therapy,  that  were  ignorant  of 
its  first  principles,  and,  too,  where  most  of  their  teachings 
had  been  erroneous.  A  physician,  a  few  months  ago,  called 
to  see  me,  who  was  taking  a  course  of  instruction  in  electro- 
therapy. I  asked  him  what  were  their  teachings  regarding 
the  properties  of  the  sinusoidal  current.  He  said  tliat  one 
of  his  professors  had  said  that  it  was  the  same  in  effect  as 
the  faradic  currents.  I  then  gave  him  a  list  of  questions 
to  ask  his  professors  regarding  the  properties  of  the  direct 
and  alternating  incandescent  currents,  the  sinusoidal  and 
induced.  On  the  following  day  he  reported  at  my  office, 
and  stated  that  he  had  propounded  the  queries,  as  I  had 
suggested,  to  each  of  the  lecturers,  and  that  neither  of 
them  agreed  upon  any  point. 

A  lack  of  knowledge  of  physics  and  the  properties  of  the 
different  electric  currents,  as  evidenced  by  teachers  and 
writers  upon  the  subject,  has  evidently  given  rise  to  the 
following  from  Dr.  S.  H.  Morrell,  in  the  Times  and  Reg- 
ister, March  16,  1895,  on  "A  Plunge  into  Electro- 
Therapeutics,'"  who  gives  some  wholesome  advice  to  be- 
ginners which  thoroughly  accords  with  my  views.  He 
says:  "If  you  wish  to  acquire  skill  in  the  use  of  electric- 
ity, don't  set  about  it  alone,  and  don't  rely  on  what  you 
find  in  text-books.  If  you  can  induce  a  reliable  expert  to 
take  you  as  a  student  for  a  few  months,  do  so,  no  matter 
what  it  costs.  As  there  are  various  branches  of  electrical 
work  in  which  special  technique  is  employed,  for  instance 
in  genito-urinary  and  gynecological  practice,  you  should 
obtain  a  short  course  of  practical  instruction  in  each. 
When  you  have  devoted  six  months  to  an  apprenticeship 
of  this  kind,  you  will  have  laid  the  foundation  for  ultimate 
success." 

I  mention  these  facts  only  to  illustrate   why  electro- 


ELECTRO-PHYSICS.  177 

therapy  is  still  regarded  by  many  of  our  leading  physicians 
as  suh  judice,  who  have  not  given  it  special  attention  or 
clinical  study. 

Many  of  the  most  scientific  physicians  in  the  world  at- 
test the  fact  that  by  the  proper  selection  of  the  currents 
and  accessories,  and  its  appropriate  application  to  certain 
pathologic  structures,  it  relieves  the  morlhfic  conditions 
with  the  impunity  that  cannot  be  effected  by  any  other 
means  known  to  science. 

The  proper  use  of  so  intricate  and  yet  so  worthy  a 
remedy  could  not  be  brought  to  perfection  l3y  a  merely 
superficial  series  of  experiments,  nor  can  at  present  a  pass- 
ing glance  at  a  standard  author  warrant  sufficient  knowl- 
edge for  successful  treatment  by  its  use.  The  different 
currents  and  different  strengths,  each  are  studies  in  them- 
selves that  demand  careful  perusal  on  the  part  of  the 
student,  of  each  and  every  form  separately,  as  though  it 
were  an  independent  study  bearing  only  a  distant  relation 
to  the  common  subject.  This  accounts  for,  in  part,  why 
the  general  practitioner  too  frequently  wholly  neglects  the 
agent  that  will  bring  about  the  best  results  in  the  treat- 
ment of  his  patients  suffering  from  prostatitis,  and  resorts 
to  the  use  of  drugs  that  will  frequently  do  infinitely  more 
harm  than  no  treatment  at  all.  Xot  that  it  is  a  willful 
neglect  on  the  part  of  a  conscientious  physician  who  always 
tries  to  do  the  best  by  his  patients,  but  rather  because,  even 
though  he  would  have  sufficient  time  amid  his  numerous 
duties  to  study  thoroughly  the  applications  of  the  different 
currents,  facilities  for  their  use  and  necessary  equipment 
in  order  to  justify  gratifying  results  would  be  wanting. 
In  short,  electrical  treatment  is  a  specialty  that  demands 
for  the  successful  management  of  cases  a  specialist  who 
can  devote  the  greater  part  of  his  time  to  the  supervision 
of  special  apartments  and  special  equipments  that  cannot 


178  ELECTRO-PHYSICS. 

receive  ^lecessary  attention  in  the  busy  routine  of  a  general 
practice.  In  the  hands  of  such  a  one  sufficiently  skilled  to 
cope  with  the  various  forms  of  chronic  prostatitis,  and 
possessing  all  requisite  appliances,  the  efficacies  of  electrical 
treatment  cannot  fail  to  prove  itself  as  being  far  superior 
to  all  agents  that  may  be  employed  for  the  relief  of  thi& 
form  of  disease. 

Electricity,  like  all  other  potent  remedies,  has  its  limit 
of  utility,  and  it  is  only  within  these  bounds  that  its  bene- 
fits are  claimed  by  the  author. 

Electricity  yields  negative  results  wherever  its  applica- 
tion is  not  thoroughly  understood,  as  where  the  galvanic 
current  is  applied  where  the  faradic  or  sinusoidal  should 
be  used ;  or  when  too  weak  or  too  strong  a  current — either 
has  no  effect  or  irritates  the  parts ;  or  when  it  is  made  to 
comprise  the  whole  treatment,  and  no  pains  are  taken  to 
ascertain  the  underlying  cause  of  the  disease  and  that  also 
judiciously  treated,  nor  to  build  up  the  general  system  in 
conjunction  with  this  treatment.  As  is  the  folly  of  treat- 
ing a  patient  with  tonics  with  a  view  of  adding  weight  to 
his  body,  and  still  denying  him  the  proper  food  for  the 
accomplishment  of  that  purpose  obviously  evident,  so  also 
should  be  the  treatment  of  a  patient  by  electricity  without 
attention  to  general  hygienic  principles.  The  efficacies  of 
electro-therapeutics  are  denied  by  many  physicians  who,  in 
good  faith,  have  never  devoted  sufficient  time  to  the  study 
of  its  proper  application,  and  hence  every  trial  has  been 
attended  by  failure;  and  those  who,  skeptically  biased, 
have  never  directed  their  attention  to  its  uses,  and  in 
order  to  smother  its  growing  popularity  declare  it  harmful 
in  effect  and  too  dangerous  for  use. 

Because  a  remedy  is  not  rightly  understood  and  its  use 
is  not  attended  with  success  merely  for  want  of  knowledge 
on  the  part  of  those  who  deny  proper  time  to  its  study,  it 


ELECTRO-PHYSICS.  179 

does  not  necessitate  abandonment  on  the  part  of  others 
who  are  thoroughly  versed  in  its  effects,  and  in  whose 
hands  it  does  not  fail;  and  much  less  should  it  be  under- 
valued because  subtle  charlatans  with  medical  pretenses 
ensnare  unwary  victims  by  its  improper  uses.  In  the 
hands  of  an  incompetent  physician  most  all  therapeutic 
agents  are  dangerous,  be  it  an  opiate,  massage  or  mustard ; 
and  electricity  is  no  exception  to  the  rule;  yet  who  would 
decry  the  beneficial  effects  of  an  opiate  prescribed  by  an 
able  physician.  And  since,  therefore,  most  of  our  worthy 
remedies  have  a  dangerous  side,  if  carelessly  employed, 
why  then  should  the  use  of  the  electrical  current  be  aban- 
doned when  other  agents,  infinitely  more  dangerous,  still 
maintain  full  sway  in  the  treatment  of  diseases  ? 

Electrical  treatment  is  a  method  of  treatment  that  has 
come  to  stay.  Prejudice  cannot  uproot  it,  nor  bungling 
usage  soil  successful  records.  Yearly,  as  new  and  more 
efficient  methods  and  apparati  are  brought  into  use,  its 
range  of  employment  grows  larger  and  its  triumphs  of 
success  become  more  apparent.  And  today,  from  among 
all  the  various  agents  for  the  successful  treatment  of  dis- 
eases of  the  prostate,  electricity,  in  conjunction  with  suit- 
able medicinal  remedies,  incontrovertibly  stands  in  the 
front  rank. 


CHAPTEE  IX. 

ELECTRO-PHYSICS. — CONTINUED. 

All  substances,  whether  organic  or  inorganic,  are  capable 
of  electric  excitation.  The  electricity  thus  excited  affects 
bodies  differently.  This  difference  in  -the  electric  condi- 
tion of  one  body  as  compared  with  that  of  another  consti- 
tutes what  is  termed  electrical  potential.  Bodies  are  not 
under  all  circumstances  of  the  same  electrical  potential; 
in  fact,  they  vary  very  much  in  this  respect.  An  element 
of  higher  potential  is  positive  to  one  of  lower  negative,  yet 
negative  to  another  still  higher.  For  instance,  zinc  is 
positive  when  coupled  with  copper,  yet  negative  with 
sodium.  The  term  potential,  therefore,  is  a  relative  one. 
The  earth  is  usually  taken  as  the  standard,  and  assumed 
to  be  at  zero  potential. 

All  energy  or  chemic  action  exerted  upon  bodies  of 
different  potentials  evolves  electricity,  and  there  is  a  con- 
stant tendency  toward  the  establishing  of  an  equilibrium 
between  them,  by  the  passing  of  the  current  from  the 
positive  or  higher  potential  to  the  negative  or  lower. 

There  being  no  absolute  non-conductors,  all  bodies  would 
soon  be  brought  to  an  electric  equipoise  were  it  not  for 
the  constant  generation,  or  evolution,  of  electricity  by 
energy  or  chemical  action  as  exerted  upon  bodies  of  dif- 
ferent potentials.  It  is  a  mistaken  idea,  as  expressed  by 
many,  that  the  energy  exerted  by  the  diurnal  and  annual 
revolutions  of  the  earth  produces  an  inexhaustible  supply 
of  electricity.  As  the  earth  revolves  through  ethereal  space 
there  is  no  friction,  no  energy  exerted;  hence  there  could 

180 


ELECTRO-PHYSICS.  181 

be  uo  electricity  evolved.  Astronomers  agree  that  the 
earth  has  not  lost  a  fraction  of  a  second  of  time  for  hun- 
dreds of  years;  this  would  be  impossible  were  there  suffi- 
cient friction  or  energy  exerted  to  evolve  electricity. 

There  are  three  ways  by  which  electricity  is  transmitted 
between  bodies,  viz.,  conduction,  induction  and  convection. 
It  flows  in  direct  proportion  to  the  conducting  media  and 
inversely  as  to  the  resistance ;  though  always,  other  things 
being  equal,  in  the  direction  of  the  least  resistance. 

Conduction  is  the  property  possessed  by  bodies  of  trans- 
mitting electricity  from  positive  to  negative,  when  the 
conductive  body  is  brought  in  direct  contact  with  each  pole. 

A  knowledge  of  the  relative  conductivity  and  resistance 
of  bodies,  used  in  the  construction  of  batteries  and  appur- 
tenances, is  indispensable  to  a  thorough  understanding  of 
electro-physics,  electro-physiology,  electro-therapy  and 
electro-surgery. 

The  best  conductors  for  all  practical  purposes  are  copper, 
zinc  or  silver.  The  size  of  the  wire  in  the  conducting 
cords  must  also  be  considered,  as  the  conductivity  of  the 
current  is  influenced  markedly  thereby.  Especially  should 
this  precaution  be  observed  when  using  a  current  of  large 
volume  or  amperage,  as  in  applications  of  the  cautery 
current.  Those  of  high  tension  and  low  amperage,  how- 
ever, do  not  require  such  large  cords. 

The  term  conduction  is  a  relative  one.  The  best  con- 
ductors give  a  certain  amount  of  resistance,  and  the  longer 
the  distance  the  current  traverses  from  the  generator  or 
battery,  the  greater  is  the  resistance,  or  impaired  force  of 
the  current,  other  things  being  equal.  As  before  stated,  a 
large  collection  or  size  of  wires  overcome  this  to  a  great 
extent.  There  are  also  certain  very  poor  conductors,  or 
practically  non-conductors  (yet  in  fact  there  are  no  non- 
conductors so  far  known  to   science),  that  are  used  as 


182  ELECTRO-PHYSICS. 

insulators.  Insulation  means  the  prevention  of  the  ©scape 
of  electricity  from  a  conducting  body,  or  wire,  by  so-called 
non-conductors.  Glass,  rubber,  silk,  wool,  German  silver 
and  graphite  are  those  in  general  use. 

Owing  to  the  great  resistance  offered  by  German  silver 
to  the  flow  of  the  electric  current,  and,  too,  its  property  to 
withstand  heat,  it  is  very  much  used  in  the  construction  of 
rheostats.  Graphite  is  also  extensively  used  for  the  same 
purpose.  These  two  substances  are  used  almost  exclusively 
in  the  manufacture  of  rheostats  for  utilizing  the  incandes- 
cent currents,  both  direct  and  alternating,  for  medical  and 
surgical  purposes. 

Induction  is  the  force  exerted  upon  bodies  brought 
within  the  field  of  an  insulated  electric  current,  or  magnet. 
This  force  is  exerted  by  the  attractive  and  repulsive  prop- 
erties of  atmospheric  molecules,  interposed  between  the 
insulated  current,  or  magnet,  and  the  hodj  in  close  prox- 
imity thereto. 

By  way  of  illustration,  suppose  a  positive  or  negative 
pole  of  a  magnet  is  brought  within  close  relation  to  a 
plate  of  soft  iron,  though  not  in  contact.  The  latter  would 
become  magnetized  by  induction.  This  is  accomplished  oy 
the  well-known  law  of  physics,  that  unlike  attracts  and 
like  repels.  The  magnetic  pole,  whether  negative  or  posi- 
tive, attracts  the  atmospheric  molecules  interposed  between 
it  and  the  iron  plate.  The  molecules  thus  attracted  be- 
come charged  with  the  same  magnetism,  and  are  immedi- 
ately repulsed  (like  repels  like) ;  they  are  driven  from  the 
magnetic  pole  and  strike  the  iron  plate  and  impart  to  it 
the  force  obtained  from  the  magnet.  These  molecules  are 
so  numerous  and  rapid  in  their  course  that  they  maintain 
magnetic  properties  in  the  iron  plate  just  so  long  as  it  is 
retained  within  the  field  of  the  magnetic  influence. 

A  somewhat  similar  experiment  of  induction  may  be 


ELECTRO-PHYSICS.  183 

given  by  the  passage  of  a  continuous  electric  current 
through  an  iusuiated  wire  surrounding  a  soft  iron  core, 
when  a  second  insulated  wire  is  wound  over  the  first,  but 
having  no  direct  connection  with  it.  A  current  is  pro- 
duced in  the  second  wire  by  induction,  and  passes  always 
in  the  opposite  direction  to  that  of  the  primary  current. 

Magnetism  and  electricity  are  interchangeable  forces,  or 
different  manifestations  of  the  same  force,  as  they  are 
readily  convertible  one  into  the  other.  The  earth  being 
the  reservoir  or  store  house  of  all  unused  electricity,  it 
therefore  constitutes  one  great  magnet,  into  which  all  over- 
charged bodies  of  a  higher  potential  tend  to  unload,  as  is 
illustrated  by  the  lightning  from  the  clouds  passing  to  the 
earth.  Moisture  favors  conductivity;  hence  the  zig-zag 
form  of  lightning  in  its  passage  to  the  earth. 

Medical  Electkicity. 

Electric  currents  are  produced  in  different  ways.  Chief 
among  these,  in  so  far  as  this  work  is  concerned,  are  those 
generated  by  dynamos,  cell  batteries  and  static  machines. 
Dynamos  are  so  constructed  as  to  produce  two  different 
forms  of  current,  the  direct  incandescent  or  Edison  cur- 
rent, and  the  alternating.  The  direct  incandescent  current 
and  the  galvanic  current,  as  generated  by  cell  batteries 
(not  the  cautery)  are  the  same  in  effect. 

Whenever  the  direct  incandescent  current  of  the  110 
volt  circuit  is  accessible,  I  would  advise  it  to  be  used  always 
in  preference  to  that  of  any  cell  battery,  for  several  rea- 
sons. First,  because  it  is  regular  and  constant.  Whether 
used  five  minutes  daily,  all  day  or  even  a  year,  the  current 
is  invariable,  accurately  measured  and  of  known  electro- 
motive force.  The  cell  battery  must  necessarily  become 
weakened  by  use,  as  caused  by  the  corroding  of  the  positive 
element  and  exhausting  of  the  excitant  fluid. 


184  ELECTRO-PHYSICS. 

There  are  various  kinds  of  apparati,  or  batteries  and 
accessories,  made  for  the  purpose  of  utilizing  the  direct 
incandescent  current,  by  modifying  them  in  various  ways, 
for  therapeutic  purposes.  They  all  tend  to  produce  the 
same  result  of  so  harnessing  the  currents  as  to  use  any- 
where from  one  to  one  hundred  volts,  and  so  modifying 
them  as  to  meet  therapeutic  indications. 

Anyone  thoroughly  familiar  with  the  mechanism,  the 
separate  uses  of  the  apparati  and  the  different  properties 
of  the  currents  can  handle  them  with  impunity.  A  novice 
is  much  less  likely  to  do  harm  with  the  direct  incandescent 
current  than  with  a  cell  battery  constructed  to  produce  the 
same  electro-motive  force.  Still  another  advantage  is  that 
it  gives  only  two-fifths  of  an  ampere,  while  cell  batteries 
give  from  one  to  one  and  a  half  ampere,  and  are,  in  con- 
sequence, much  more  iritating  in  procuring  the  same 
current  strength.  Cell  batteries  are  troublesome  and  ex- 
pensive to  keep  in  order,  even  by  an  expert;  and  often 
just  at  the  critical  moment  there  occurs  a  break  in  the 
circuit  from  an  exhausted  cell  or  from  other  causes.  Good 
work,  however,  can  be  accomplished  by  means  of  them, 
although  they  require  constant  attention  and  testing  to 
insure  their  being  in  good  working  order.  While  the 
electro-motive  force,  or  voltage,  as  produced  by  cell  bat- 
teries, depends  upon  the  number,  quality  and  condition  of 
the  cells  in  the  circuit,  yet  the  amperage,  or  volume, 
remains  about  the  same  whether  one  cell  is  used  or  one 
hundred;  that  is,  when  the  positive  and  negative  elements 
are  alternately  connected. 

Galvanic  Cell. 

If  two  elements,  metallic  or  non-metallic,  differing  in 
electrical  potential,  be  connected  at  one  extremity  by  a 
conductor   and   immersed   in  a   fluid    capable  of   chemie 


ELECTRO-PHYSICS.  185 

action  upon  the  higher,  there  is  at  once  produced  an  elec- 
tric current  which  passes  from  the  higher  or  positive  ele- 
ment to  the  lower  or  negative.  Substances  so  arranged  in 
a  cup  constitute  a  galvanic  cell. 

The  more  the  elements  composing  a  galvanic  cell  differ 
in  electrical  potential,  all  other  things  being  equal,  the 
greater  in  direct  proportion  is  the  electro-motive  force 
arising  therefrom.  For  example,  a  cell  constructed  of 
zinc  and  carbon  generates  a  stronger  current  than  one 
constructed  of  zinc  and  copper. 

Galvanic  cells  are  constructed  with  regard  both  to  cost 
and  utility.  Zinc  is  used  almost  exclusively  as  the  positive 
element;  carbon  or  copper  as  the  negative.  The  cells  in 
most  general  use  are  the  Bunsen,  Leclanche,  gravity  and 
dry,  with  their  various  modifications  as  made  by  different 
manufacturers.  For  all  practical  purposes,  the  open 
circuit  cetl  is  best  suited  for  stationary  office  batteries,  as 
there  is  but  little  action  or  deterioration  of  elements  except 
when  in  use.  The  only  disadvantage  attached  to  it  is  tha^, 
it  cannot  be  used  for  any  continuous  length  of  time,  since 
it  requires  rest  to  recuperate  after  an  hour  or  more  of 
constant  use.  Only  a  few  minutes  are  required,  however, 
to  restore  its  activity.  It  is  now  the  only  cell  used  for 
stationary  ofiice  batteries,  where  the  direct  incandescent 
current  is  inacessible. 

The  positive  electricity  arises  from  the  zinc  plate,  passes 
through  the  fluid  to  the  carbon,  and  out  through  the  wire 
attached  thereto,  as  the  anode  or  positive  pole,  although  it 
is  the  negative  element.  The  wire  attached  to  the  zinc 
(the  positive  element)  is  the  cathode  or  negative  pole. 
When  these  wires  are  brought  together  there  is  formed  a 
close  circuit;  when  they  are  not  connected  there  is  an 
open  circuit. 

The  Bunsen  cell  is  composed  of  zinc  and  carbon  ele- 


186  ELECTRO-PHYSICS. 

ments,  with  dilute  sulphuric  acid  as  the  exciting  fluid  and 
bichromate  of  potash  to  prevent  polarization.  It  was  for 
a  long  time  the  principal  one  used  in  galvanic  and  faradic 
batteries,  but,  being  objectionable  to  use  on  account  of  the 
fumes  and  corrosive  properties  of  the  sulphuric  acid,  it  has 
been  supplanted  by  the  open  circuit  cells.  Besides,  the 
Bunsen  cell  is  troublesome  to  use,  inasmuch  as  the  elements 
must  be  removed  from  the  fluid  when  not  in  use;  other- 
wise they  will  be  destroyed. 

The  open  circuit  cells  (which  include  the  dry,  Leclanche, 
and  their  various  modifications)  of  zinc,  carbon,  with 
muriate  of  ammonia  as  the  exciting  fluid,  are  the  ones 
now  in  general  use.  They  are  less  troublesome,  require 
less  repairing,  and  give  a  more  constant  current.  The 
elements  are  not  removed  from  the  cups  after  using,  and, 
with  ordinary  use,  require  attention  less  often  than  any 
other  form  of  cell. 

The  Galvanic  Battery. 
"\¥hen  two  or  more  cells  are  so  arranged  that  the  zinc  of 
one  is  connected  with  the  carbon  of  another,  there  is  formed 
a  compound  circuit,  or  galvanic  battery.  The  different 
kinds  of  cells  are  all  similarly  connected  in  this  arrange- 
ment for  a  battery. 

The  Galvanic  Cuerent. 

The  current  that  flows  through  these  various  cells,  when 
in  proper  connection,  is  known  as  the  continuous  or  gal- 
vanic current.  It  is  a  current  that  traverses  the  circuit 
uninterruptedly  and  with  a  uniform  strength  varying  in 
proportion  to  the  power  and  endurance  of  the  cells. 

In  considering  the  construction  of  the  galvanic  battery 
we  must  call  attention  to  the  two  closely  allied  yet  distinct 
forms  of  current  capable  of  being  generated  by  the  bat- 
teries properly  constructed  for  each.     They  are  intensity 


ELECTRO-PHYSICS.  187 

and  quantity  currents,  or,  in  other  words,  the  continuouB 
current,  as  produced  by  an  ordinary  galvanic  battery  or 
dynamo  and  the  cautery  current. 

By  way  of  differentiating  these  two  forms,  and  in  order 
to  demonstrate  their  distinct  utility,  let  us  imagine  two 
streams  of  water  taking  their  origin  from  two  separate 
reservoirs  at  the  top  of  a  mountain.  The  reservoirs  are 
equal  in  dimensions,  and  capable  of  an  equal  supply ;  they 
lie  on  the  same  level,  and  the  descent  of  their  streams  is 
similarly  gradual  throughout  their  separate  courses  to  the 
point  where  they  diverge  to  turn  water-wheels.  Suppose 
that  the  orifice  through  which  one  of  these  reservoirs  feeds 
its  stream  should  become  partly  occluded.  As  a  result 
the  outward  flow  would  be  in  a  proportionate  degree  shut 
off.  The  accumulation  of  pent-up  water  would  produce 
within  the  reservoir  a  pressure  that  in  turn  would  cause 
the  stream  to  gush  forth  with  greater  impetus.  Sweeping 
along  it  would  strike  its  wheel  with  much  greater  force, 
but,  lacking  the  volume  of  the  other  stream,  by  reason  of 
the  occlusion  at  its  source,  would  accomplish  the  same  work 
differently. 

So  it  is  with  the  currents  of  the  intensity  and  quantity 
batteries.  The  intensity  current,  by  virtue  of  its  cell  con- 
struction (the  elements  being  smaller  and  alternately 
connected,  and  the  distance  between  these  elements  and 
between  the  different  cells  being  greater),  like  the  stream 
impeded  at  its  source,  is  resisted  in  its  flow  from  one 
element  to  another  and  also  from  one  cell  to  another. 
Thus  it  loses  in  quantity  but  gains  in  impetus  or  intensity. 
This  is  the  form  of  galvanic  current  employed  in  medical 
treatment. 

The  quantitative  current,  by  reason  of  the  proximity  of 
its  elements,  the  greater  dimensions  and  exposure  in  sur- 
face of  these  elements,  and  the  comparatively  little  resist- 


188  ELECTRO-PHYSICS. 

ance  offered  in  its  course,  like  the  unimpeded  stream, 
flows  through  the  circuit  in  greater  quantity  and  gives 
virtually  more  power  when  used  for  motor  or  heating 
purposes.  It  differs  from  the  intensity  current  in  that  its 
volume,  passing  through  the  circuit  at  a  given  time,  is 
greater  and  more  uniform,  while  that  of  the  latter  is  less, 
yet  more  violent  in  form  and  of  greater  impetus. 

If  these  two  forms  of  the  galvanic  current  were  succes- 
sively passed  through  a  cautery  knife,  it  would  be  dis- 
covered that  while  the  current  from  the  quantity  battery 
would  produce  a  white  heat  in  the  platinum  blade,  the 
passage  of  a  current  from  an  intensity  battery  would 
produce  no  perceptible  effect  and  probably  not  even  warm 
it.  To  explain  this  let  us  again  refer  to  our  illustration. 
Should  the  channels  of  both  streams  become  similarly 
narrowed  in  their  onward  flow,  it  is  evident  that  the  stream 
whose  progress  had  thus  far  been  unimpeded  would,  by 
reason  of  its  greater  quantity  of  water,  be  more  powerful; 
while  the  other,  with  far  greater  impetus,  would  again 
lack  the  volume  to  be  of  any  avail.  In  flowing  through 
the  cautery  knife,  the  quantitative  current  traverses  a 
platinum  wire,  or  blade,  too  small  to  carry  the  volume  of 
current  without  great  resistance  in  its  passage ;  as  a  result 
the  current  at  this  point  is  impeded  in  its  flow,  compressed 
into  less  area,  rendered  more  compact,  and  hence  heats  the 
platinum  point.  The  intensity  current,  however,  lacking 
in  volume,  is  not  rendered  sufficiently  compact  to  even 
warm  the  blade,  and  it  is  only  when  this  is  passed  through 
an  intensely  resistant  and  equally  slender  film  (as  bamboo 
in  the  incandescent  light)  that  the  current  will  be  sufii- 
ciently  condensed  to  produce  heat  and  light. 

This  is  the  reason  why  we  cannot  have  a  battery  that 
will  serve  for  both  medical  and  cautery  purposes  without 
change  of  construction.     An  intensity  battery  may,  how- 


ELECTRO-PHYSICS.  189 

ever,  be  converted  into  a  quantity  battery  by  connecting  all 
the  zincs  of  the  different  cells  to  one  another,  so  also 
joining  all  the  carbons,  and  finally  closing  the  circuit  by 
connecting  the  first  zinc  with  the  last  carbon.  But  this 
arrangement  is  impractical  and  never  used. 

Another  simple  illustration  of  the  difference  between  the 
two  currents  is  as  follows:  Suppose  an  ordinary  hose,  one 
inch  in  diameter,  is  attached  to  a  water  plug  of  great 
pressure,  and  the  water  turned  on.  While  it  would  throw 
a  stream  of  water  some  thirty  or  forty  feet  by  means  of  the 
force  exerted  by  the  high  pressure,  yet  should  this  stream 
of  water  be  thrown  against  a  water-wheel  four  or  five  feet 
in  diameter,  it  would  have  no  effect  upon  it.  On  the  other 
hand,  a  stream  of  water  two:  feet  in  diameter,  of  small 
force — even  one-twentieth  of  that  from  the  hose — if  turned 
upon  the  water-wheel  would,  because  of  its  volume  and 
weight,  begin  to  move  it  immediately. 

The  units  of  measurement  of  these  two  forms  of  electric 
currents  will  be  hereafter  given. 

Construction  of  Batteries. 

There  is  a  great  difference  in  the  quantity  of  current 
generated  by  both  the  galvanic  and  faradic  batteries. 
Very  many  bateries  of  cheap  construction  are  annually  sold 
to  the  profession  and  laity.  The  currents  in  these  are  so 
intensely  irritating  and  irregular  that  it  is  impossible  to 
obtain  any  uniform  results  by  their  use. 

The  quality  of  the  galvanic  current  depends  largely 
upon  the  cells  used  and  the  condition  in  which  they  are 
kept,  while  that  of  the  faradic  depends  mainly  upon  the 
construction  of  the  coil.  In  regard  to  the  current  as 
taken  from  the  direct  incandescent  circuit,  it  is  regular  and 
invariable.  Apparati  are  also  constructed  by  means  of 
which  this  current  can  be  converted  into  great  volume  or 


190 


ELECTRO-PHYSICS. 


increased  amperage,  whereby  it  can  be  utilized  for  cautery 
purposes.  This  is  first  accomplished  by  means  of  a  motor 
so  constructed  as  to  convert  the  direct  into  an  alternating 
current,  thence  from  the  alternate  by  means  of  a  second 
apparatus,  called  a  transformer,  into  increased  amperage, 
which  can  be  used  for  cautery. 

The  Faradic  Currents. 

When  a  current  from  one  or  more  cells  passes  around  a 
bar  of  soft  iron  through  an  insulated  wire,  it  magnetizes 
this  bar  or  helix  by  induction.  This  remains  magnetized 
as  long  as  the  circuit  is  closed,  but  is  immediately  demag- 
netized when  the  circuit  is  broken. 


Fig.  XXV. 

Fig.  XXV.  illustrates  the  construction  of  a  faradic  bat- 
tery, from  which  we  obtain  the  induced  or  faradic  currents. 

By  tracing  the  current  from  the  carbon  element  c,  fol- 
lowing the  arrow  up  to  the  post,  out  to  the  point  of  the 
screw,  and  from  there  down  the  spring  a,  to  which  is 
attached  an  insulated  wire  that  passes  up  and  around  the 
bar  of  soft  iron  and  back  to  z,  we  have  a  closed  circuit 
which  attracts  the  piece  of  iron  attached  to  the  spring  at 
a  and  draws  it  to  6.     In  so  doing  it  removes  the  spring 


ELECTRO-PHYSICS.  191 

from  the  tip  of  the  screw  (as  is  shown  by  tlie  dotted  linec) 
and  breaks  the  circuit  at  this  point.  The  circuit  being 
broken,  the  bar  of  soft  iron  becomes  demagnetized,  and, 
the  induction  in  the  coil  of  wire  being  severed,  the  spring 
flies  back  to  its  former  position.  As  soon  as  the  spring 
strikes  the  point  of  the  screw,  the  circuit  is  again  closed; 
but  also  as  quickl}'  broken  when  the  bar  of  soft  iron  again 
becomes  magnetized.  Thus  b}^  rapid  making  and  break- 
ing of  the  circuit,  a  current  is  produced,  which  is  s3'nony- 
mously  termed  the  induced,  faradic  or  interrupted  current. 

The  Secondary  Induced  or  Faradic  Current. 

If  a  second  insulated  wire  is  wound  around  this  first  or 
primary  cell,  but  not  connected  with  it,  and  the  current  is 
passed  through  the  primary  wire,  there  is  generated  at  the 
same  time  in  the  superadded  coil  a  second  current  which 
flows  through  it  in  an  opposite  direction.  As  this  second 
coil  is  entirely  independent  of  the  first,  so  far  as  direct 
connection  is  concerned  (the  wire  merely  running  from 
the  right  S,  around  the  primary  coil  and  back  to  the  left 
post  S),  the  current  is  therefore  produced  solely  by  in- 
duction, and  is  known  as  the  secondary  induced,  faradic 
or  interrupted  current.  As  compared  with  the  primary, 
it  is  much  more  intense,  yet  with  great  resistance  inter- 
posed it  is  soothing  and  acts  as  an  analgesic. 

In  regard  to  the  question  so  frequently  asked  me,  "What 
kind  or  make  of  battery  would  you  advise  me  to  get  ?"  one 
should  first  decide  whether  the  battery  is  intended  exclu- 
sively for  the  office  or  for  portable  use  also.  A  good  gal- 
vanic battery,  with  sufficient  number  of  cells  to  give  de- 
sired force,  must  necessarily  be  cumbersome  to  carry 
around.  One  constructed  with  dry  cells  is  lighter  and 
more  convenient;  yet  I  would  never  advise  the  procuring 
jf  a  portable  galvanic  battery  for  general  use. 


192  ELECTRO-PHYSICS. 

Units  of  Measueement  of  Currents. 

Cells  vary  greatly  in  regard  to  their  current,  strength 
or  electro-motor  force,  so  that  it  would  be  very  indefinite, 
in  denominating  the  electro-motor  force  of  a  current,  to 
speak  of  so  many  cells  or  such  a  cell  power.  In  order, 
therefore,  to  express  more  definitely  the  force  or  current 
strength,  certain  units  of  measurement  have  been  adopted. 
They  are  the  volt,  ampere,  milliampere  and  ohm. 

The  volt  is  the  unit  of  electro-motor  force  or  pressure,  as 
represented  in  a  Daniel  cell,  which  is  taken  as  a  standard 
and  is  usually  designated  by  E. 

The  ampere  is  the  unit  of  quantity  or  volume  of  current 
strength,  and  is  designated  by  A. 

The  ohm  is  a  unit  of  resistance,  and  is  equal  to  that 
offered  by  the  passage  of  a  current  through  eight  feet  of 
No.  35  copper  wire.     It  is  designated  by  the  letter  E. 

The  milliampere  is  the  unit  of  current  strength  that 
passes  through  one's  body  when  applied  thereto;  it  is 
represented  by  M.A.  The  resistance  includes  that  offered 
by  the  milliampere  meter,  conducting  cords,  the  electrodes 
and  the  body  of  the  patient. 

The  resistance  offered  by  the  body  varies  in  its  different 
parts,  and  bears  reference  to  its  moisture  or  dryness;  the 
mucous  membranes  offering  the  least  resistance,  and  the 
palms  of  the  hand,  when  dry,  the  greatest.  The  resistance 
of  the  current  diminishes  in  direct  proportion  to  the 
moisture  of  the  surface  of  the  body  to  which  the  electrode 
is  applied,  and  also  to  the  increased  size  of  the  electrode. 
By  way  of  illustration,  suppose  we  apply  as  indifferent 
electrode  a  sponge  or  spongiopiline,  only  one  or  two  inches 
in  diameter  and  moderately  moist,  to  the  palm  of  the 
hand;  the  resistance  would  be  so  great  that  scarcely  any 
current  strength  would  be  registered  upon  the  M.A.  meter, 


ELECTRO-PHYSICS.  193 

though  fifty  or  seventy-five  volts  were  brought'  into  the 
circuit.  Now  suppose  the  same  size  electrode  was  rendered 
quite  moist  and  the  hand  again  applied  as  before,  the 
meter  would  register  slightly  more  and  the  hand  would 
begin  stinging  and  be  rendered  very  uncomfortable;  at 
the  same  time  but  little  work  or  effect  would  be  accom- 
plished at  the  active  electrode.  On  the  other  hand,  sup- 
pose that  an  indifferent  electrode  is  used,  eight  or  ten 
inches  in  diameter  instead  of  one  or  two,  and  well  mois- 
tened, and  that  both  hands  are  placed  upon  it ;  then  fifteen 
or  twenty  volts  brought  into  the  circuit  would  diverge  the 
needle  of  the  m.  a.  meter  more  than  thrice  as  much  as 
when  the  small  electrode  was  used;  there  would  be  no 
discomfort  in  the  hands,  and  the  active  electrode  would 
accomplish  more  than  treble  the  work.  It  is,  therefore, 
evident  that  a  large  electrode  should  always  be  used  at  the 
indifferent  pole. 

The  different  manufacturers  of  electric  apparatus  have 
so  vied  with  each  other  in  constructing  cheap  instruments 
to  sell  that  a  large  majority  of  those  placed  upon  the 
market  give  rise  to  more  irritation  in  many  instances  than 
relief.  It  is  impossible  to  procure  uniformly  good  results 
with  improperly  constructed  apparati.  I  have  all  my  bat- 
teries, accessories  and  electrodes  made  to  order,  so  that  I 
know  just  what  to  expect  from  their  use. 

In  the  applications  of  any  of  the  electric  currents,  except 
certain  forms  of  the  static,  there  must  be  a  closed  circuit 
with  the  patient's  body.  And  in  these  applications  there 
are  always  an  active  and  an  indifferent  electrode.  These 
are  used  with  especial  reference  to  the  effect  it  is  desired 
to  produce.  The  active,  electrode  is  applied  to  the  dis- 
eased organ  or  part  affected,  while  the  indifferent  electrode 
may  be  placed  in  contact  with  any  portion  of  the  body 
that  is  most  convenient. 


194  ELECTRO-PHYSICS. 

In  order  to  render  the  active  electrode  more  efficient  to 
a  local  lesion  or  diseased  area,  the  electricity  must  be  con- 
centrated upon  the  part  affected.  To  accomplish  this  all 
the  other  portion  of  the  electrode  must  be  insulated  except 
that  in  immediate  contact  with  the  diseased  organ.  By 
this  means  the  healthy  tissue  is  protected  from  the  electro- 
lytic action  of  the  current.  The  localized  effect  of  the 
active  electrode  may  be  still  further  increased  by  counter- 
acting the  resistance  interposed  at  the  indifferent  electrode. 
This  may  be  accomplished  by  increasing  the  surface  of  the 
latter,  and  having  it  quite  moist.  The  surface  of  the  skin 
gives  marked  resistance  to  the  passage  of  the  current  when 
dry.  This  can  be  overcome,  for  all  practical  purposes,  by 
means  of  a  moist  and  large  size  electrode.  The  latter 
should  be  at  least  six  or  eight  inches  in  diameter. 

The  conductivity  of  any  tissue  of  the  body  is  in  direct 
proportion  to  its  moisture.  Hence  the  mucous  surfaces 
are  much  better  conductors  than  the  skin.  The  current 
passes  from  the  positive  to  the  negative  pole  and  in  the 
direction  of  the  least  resistance,  which  is  usually  the  short- 
est route  between  the  two  poles.  That  portion  of  the  body 
through  which  the  electricity  passes,  except  in  the  imme- 
diate vicinity  of  the  poles,  is  very  little  influenced  by  the 
current,  as  it  mainly  acts  as  a  conductor. 

Physiological  Effects  of  Electric  Currents. 
The  properties  of  all  electric  currents,  just  as  that  of 
magnets,  are  limited  at  or  near  their  poles.  I  do  not  mean 
that  only  that  part  of  the  electrode  which  is  in  immediate 
contact  is  active,  but  the  activity  is  greatest  when  exerted 
nearest  the  pole,  and,  as  it  recedes  therefrom,  diminishes 
in  direct  proportion  to  the  strength  of  the  current  used, 
and  inversely  as  to  the  distance  from  the  poles.  This  area 
may,  therefore,  vary  from  one  to  twelve  or  more  inches. 
The    polar  effect  of  certain    currents,  however,  may  be 


ELECTRO-PHYSICS.  195 

exerted  upon  an  organ  and  transmitted  to  some  remote 
part  of  the  body.  For  instance,  a  nerve  may  be  stimulated 
at  or  near  its  origin  by  the  sinusoidal  or  the  interrupted 
galvanic  current,  when  the  muscles  to  which  it  is  distrib- 
uted are  made  to  contract  several  feet  distant. 

The  effect  of  the  anode  of  the  galvanic  current,  aside 
from  that  of  the  electro-negative  elements,  is  soothing 
contracts  capillaries  and  acts  as  a  hemostatic;  while  that 
of  the  negative  is  stimulating,  dilates  capillaries  and  tends 
to  induce  hemorrhage. 

Labile  or  stable  applications  of  the  continuous  galvanic 
current  acts  mainly  by  way  of  electrolysis,  cataphoresis 
and  its  stimulating  effect  upon  the  skin  and  circulation  at 
its  poles. 

The  sensation  of  slight  burning  at  either  of  these  poles 
is  due  to  the  action  of  the  chemic  elements  as  result  of 
electrolysis,  and  not  to  any  heat  in  the  electrodes,  since 
there  is  no  elevation  of  temperature  in  the  latter. 

The  interrupted  galvanic  current  is  exceedingly  stimu- 
lating to  nerves,  muscles  or  any  organ  to  which  it  is  ap- 
plied. It  is  more  penetrating  than  the  induced  currents, 
and  is  especially  indicated  in  the  treatment  of  the  deep- 
seated  organs.  The  rapid  interruptions  cause  contractions 
and  relaxation  of  the  unstripped  muscular  fibers  of  blood 
vessels,  which  restores  their  tonicity,  relieving  thereby 
engorgement  of  congested  organs. 

The  physiological  effects  of  the  faradic  currents,  both 
primary  and  secondary,  are  stimulating  tonics.  They  have 
no  chemic  or  electrolytic  action,  and  they  exert  their  tonic 
properties  chiefly  in  a  mechanical  way.  These  properties 
might  be  likened  to  a  gentle  though  rapid  massage.  While 
they  have  neither  cataphoretic  or  chemic  effect,  yet  their 
action  favors  medicinal" absorption  by  mechanical  excita- 
tion.    By  way  of  illustration,  suppose  a  medicine  is  applied 


196  ELECTRO-PHYSICS. 

to  any  portion  of  the  body,  its  absorption  can  be  facilitated 
by  rubbing  it  within  the  skin.  This  illustrates  the  action 
of  the  faradie  currents,  except  that  they  penetrate  several 
inches  within  the  tissue.  The  secondary  induced  current 
when  applied  with  from  ten  to  twenty-five  thousand  ohms 
resistance  has  marked  analgesic  effect.  This  is  a  property 
that  is  of  special  importance  in  the  treatment  of  an  ex- 
ceedingly tender  or  irritable  j)rostate,  as  it  can  be  used 
through  the  rectum  and  applied  directly  to  the  gland.  Ee- 
lief  from  such  treatment  is  often  very  noticeable  and 
instantaneous.  Its  effect  upon  atonied  vaso-motor  nerves 
is  quite  pronounced.  By  restoring  tonicity  to  the  circular 
muscular  fibers  of  the  vessels  the  engorgement  is  relieved 
and  inflammation  reduced.  These  currents  should  never 
be  given  with  sufficient  force  to  cause  pain  or  any  un- 
comfortable sensation,  for  that  counteracts  the  benefit  that 
would  accrue  from  their  use. 

These  currents  have  a  remarkable  effect  towards  restor- 
ing tonicity  to  the  genital  organs  when  they  have  remained 
in  a  state  of  atony  or  impotency  for  so  long  a  time  that, 
even  after  the  cause  is  removed,  they  fail  to  respond  to 
normal  conditions. 

Dr.  de  Wattervill  had  advocated  the  use  of  the  combined 
faradie  and  galvanic  currents;  but  such  has  always  ap- 
peared to  me  in  the  same  light  as  a  "shotgun  prescrip- 
tion.'^ I  have  always  obtained  better  results  by  applying 
the  currents  for  specific  effects,  and  alternating  them  as 
occasion  required ;  for  instance,  instead  of  giving  the  com- 
bined galvanic  and  faradie  currents,  as  he  suggests,  for 
tonic  purposes,  I  have  always  gotten  better  results  by 
applying  the  faradie  one  day  and  the  interrupted  galvanic 
or  sinusoidal  the  next. 

While  there  is  a  marked  difference  in  the  effect  of  tlie 
poles  of  the  galvanic  currents  (and  they  should  always  be 


ELECTRO-PHYSICS.  197 

used  witK  special  reference  thereto),  yet  the  difference  in 
the  effect  of  the  poles  of  the  primary  and  secondary  in- 
duced currents  is  so  slight  that  it  matters  very  little  which 
pole  is  used  as  active  or  indifferent  in  treatment. 

The  sinusoidal  is  one  of  the  most  valuable  currents  at 
our  command  for  restoring  tonicity  to  any  organ  of  im- 
paired vitality.  It  also  possesses  in  mild  degree  electro- 
lytic, cataphoretic,  germicidal  and  mechanical  properties. 

The  rapid  alternations  of  this  current  so  act  upon  any 
molecular  body  within  several  inches  of  its  poles  that  it 
magnetizes  and  demagnetizes  the  molecules  composing  the 
body,  and,  by  the  combined  magnetic  and  mechanical  prop- 
erties of  the  currents,  so  change  their  relative  molecular 
positions  as  to  alter  their  tissue.  These  properties  are 
especially  effectual  following  the  electrolytic  changes  as  a 
result  of  interstitial  cataphoresis. 

Chemical  Effects. 

The  galvanic  current  has  the  power  of  decomposing 
chemic  compounds  both  within  and  without  the  body,  and 
breaking  them  up  into  their  original  elements.  This  can 
be  demonstrated  by  passing  the  current  through  a  solution 
of  potassium  iodide,  when  iodine  will  appear  at  one  pole 
and  potassium  at  the  other.  So  also  may  water  be  de- 
composed into  its  two  elementary  gases.  This  property 
renders  the  current  of  great  value  both  in  decomposing 
morbid  products  and  eliminating  them  from  the  body,  but 
it  is  limited  in  its  effect  to,  or  adjacent  to,  the  poles. 
Hence,  in  applying  the  current,  an  active  and  an  indiffer- 
ent polar  effect  should  always  be  taken  into  consideration. 
The  active  pole  should  be  applied  where  it  is  desired  to 
produce  a  specific  effect,  while  the  indifferent  pole  (usually 
a  broad  sponge,  so  as  to  spread  the  current  over  greater 
area,   and  consequently  render  it  inactive  at  that  pole) 


198  ELECTRO-PHYSICS. 

should  be  referred  to  some  remote  part  of  the  body.  The 
greater  the  surface  of  the  indifferent  electrode,  other 
things  being  equal,  the  more  effective  is  the  active  pole. 
The  large  majority  of  physicians  use  an  indifferent  elec- 
trode of  too  small  a  size.  It  should  not  be  less  than  eight 
inches  in  diameter. 

In  most  morbid  tissue  formation,  as  in  the  fibrous  de- 
posit of  stricture,  and  prostatic  hypertrophy,  the  vital 
activity  and  reparative  processes  are  much  below  normal 
and  are  especially  subject  to  electrolytic  action,  whereby 
the  electrolytes  composing  the  tissue  are  decomposed  into 
their  original  chemic  elements  and  the  parenchyma  of  the 
growth  is  destroyed. 

Only  certain  compounds  are  capable  of  disintegration 
by  means  of  the  galvanic  current,  which  are  known  as 
electrolytes.  As,  however,  electrolytes  form  the  chief  con- 
stituents of  the  bod}^,  electrolysis  is  possible  in  any  of  its 
tissues,  but  more  especially  in  morbid  tissue  of  low  vitality, 
that  is  incapable  of  reparation  except  by  abnormal 
processes. 

This  property  of  the  current  is  of  advantage  to  the 
surgeon  in  the  removal  of  morbid  growths,  especially  in 
such  parts  of  the  body  or  under  such  circumstances  where 
surgical  procedure  by  any  other  means  would  be  injudi- 
cious, and  at  the  same  time  attended  with  no  little  amount 
of  risk,  on  the  part  of  the  operator,  to  the  life  of  the 
patient. 

The  products  of  this,  decomposition  are  called  ions; 
those  collecting  at  the  anode,  anions,  and  those  at  the 
cathode,  cations.  Frequently  the  actual  ions  are  not  given 
off  as  such,  especially  the  anions,  which  often  combine  with 
other  substances  forming  new  compounds.  As  a  rule, 
however,  the  ions  proper  to  each  pole  may  be  distinctl}^ 
recognized.     In   inorganic  substances  this  may  be  easily 


ELECTRO-PHYSICS.  199 

demonstrated  by  passing  the  current  through  sodium 
chloride;  the  anion  will  appear  in  bubbles  at  the  positive^, 
while  sodium,  the  cation,  will  collect  at  the  negative  pole. 
Similar  changes  in  organic  substances  may  be  produced 
by  passing  the  current  through  a  piece  of  meat,  when  firm 
albuminous  eoagula  will  form  at  the  positive  pole,  and 
gases  will  be  seen  to  escape  at  the  negative.  It  will  also 
be  observed  that  the  meat  upon  the  side  of  the  anode  will 
be  dry,  while  the  other  side  will  be  moist. 

As  the  tissues  of  the  body  are  composed  largely  of  water 
and  salt,  or  chloride  of  sodium,  the  decomposition  of  these 
proximate  principles  by  chemic  action  always  results  in 
the  production  of  oxygen,  chlorine  or  hydrochloric  acid  at 
the  anode.  The  other  constituents  of  the  tissues  are  so 
insignificant  as  not  to  be  taken  into  consideration.  These 
elements  (the  anions)  have  a  strong  affinity  for  most  all 
of  the  metals  except  platinum  or  gold.  Hence,  should  a 
copper  electrode  be  introduced  into  the  urethra  and  at- 
tached to  the  anode,  with  a  closed  galvanic  circuit,  the 
oxy-chloride  of  copper  would  result.  Should,  on  the  other 
hand,  an  iron  electrode  be  similarly  used,  chloride  of  iron 
would  follow  its  use.  When  electrodes  are  used  where  the . 
electro-negative  elements  attack  and  combine  with  them 
they  are  termed  oxidizable  electrodes;  those  not  attacked 
by  these  elements  are  noted  as  non-oxidizable  electrodes. 

The  electro-positive  elements  that  occur  at  the  cathode 
do  not  combine  with  any  metal  used  as  an  electrode. 

Polar  Effects. 

If  an  ordinary  steel  needle  be  attached  to  each  pole  of 
the  batter}^,  and,  with  a  current  adapted  for  electrolysis, 
an  experiment  be  made  upon  a  piece  of  meat,  it  will  be 
noticed  that  the  products  accumulating  around  either  of 
the  poles  will  be  entirely  different  from  those  surrounding 


200  ELECTRO-PHYSICS.     * 

the  other;  that,  while  the  one  needle  is  readily  withdrawn 
and  entirely  unaffected,  the  other  will  stick  with  great 
firmness,  and,  after  being  removed,  will  show  effects  of 
having  been  subjected  to  some  chemic  change.  If  now 
the  two  parts  from  which  the  needles  were  withdrawn  be 
subjected  to  microscopical  examination,  it  will  be  seen  that 
the  part  from  which  the  unaffected  needle  was  taken  shows 
evidence  of  molecular  changes,  and  suggests  the  fact  that 
some  disorganizing  process  has  lessened  the  normal  com- 
pactness of  its  tissue;  while  in  the  other  (anode)  in  which 
the  needle  was  acted  upon,  it  will  be  found  that  there  is 
an  increase  of  material  surrounding  the  pole,  due  to  the 
coagulation  of  the  albuminous  constituents,  and  that  in 
consequence  the  tissue  is  by  far  more  compact  than  nor- 
mally. On  testing  the  chemical  reaction  of  these  products, 
those  of  the  coagulated  tissue  will  be  found  to  be  acid, 
while  the  others  are  alkaline.  These  different  phenomena 
are  invariably  proper  to  their  distinctive  poles,  and  if  the 
needles  are  left  intact  and  the  poles  reversed,  their  action 
upon  the  tissues  of  the  meat  will  also  be  reversed. 

The  experiment  demonstrates  two  distinct  effects  of  the 
current,  each  of  which  may  be  taken  advantage  of,  inde- 
pendent of  the  other,  by  the  use  of  electrodes  especially 
adapted  to  this  end;  and  from  it  we  may  also  deduce  the 
following  important  principles  of  electrolysis  as  a  guide 
to  the  use  of  the  proper  pole. 

The  positive  pole  coagulates  albumen,  causes  fibrinous 
deposits  and  attracts  electro-negative  elements,  such  as 
acids,  oxygen,  chlorine,  etc. 

The  negative  pole,  in  drawing  to  itself  alkalies  or  bases, 
collects  atoms  that  have  no  tendency  toward  combination, 
but,  being  absorbed  and  carried  away  by  means  of  the 
circulation,  lessens  the  amount  of  tissue  within  the  electro- 
lytic field. 


ELECTRO-PHYSICS.  201 

Electrolysis. 
Electrolysis  is  the  process  of  producing  chemic  decompo- 
sition and  disorganization  of  tissue  by  means  of  the  gal- 
vanic current.  In  all  compound  fluids,  dissolution,  eithei' 
slight  or  in  a  marked  degree,  is  constantly  taking  place  by 
reason  of  the  breaking  up  of  the  molecules  composing  the 
fluids  into  their  primal  atoms.  Under  normal  circum- 
stances nature  provides  for  this  disintegration  by  its 
various  processes  of  waste  and  repair,  and  no  perceptible 
changes  are  e£Eected.  Experiments  demonstrate,  however^ 
that  by  the  aid  of  the  electric  current  this  normal  decom- 
position can  be  promugated  to  such  a  degree  that  nature 
will  be  able  no  longer  to  counterbalance  the  overdrain  upon 
her  recuperative  powers,  and  hence  there  will  be  a  loss  of 
compounds  and  subsequently  of  constituents  in  the  parts 
where  the  high  amount  of  dissolution  is  made  to  take  place. 
This  change  occurs  more  readily  and  to  a  greater  extent 
in  morbid  tissue  because  of  its  defective  vital  activity  and 
its  poor  nutritive  supply. 

Cataphoresis,  or  Electric  Osmosis. 

Cataphoresis  is  the  process  by  which  fluids  are  trans- 
fused through  animal  tissue  by  means  of  the  galvanic  cur- 
rent. The  passage  takes  place  mostly  in  the  direction  of 
the  current,  viz.,  from  the  anode  to  the  cathode,  or  from 
the  positive  to  the  negative  pole.  In  order  to  pass  by  this 
process,  all  substances  must  be  in  a  state  of  solution. 
Thickness  of  animal  tissue  is  no  barrier  to  the  passage  oi 
fluids  as  induced  by  this  means. 

Diffusion  of  medicines  by  means  of  the  galvanic  current 
is  not  new ;  it  has  been  demonstrated  by  various  physicians 
both  in  this  country  and  in  Europe.  But  it  is  only  within 
the  past  decade  that  it  has  been  systematically  used  and 
with  a  knowledge  of  its  actual  effects. 


203  ELECTRO-PHYSICS. 

T.  A.  Edison  read  a  paper  before  the  International 
Congress  at  Berlin  in  August,  1900,  in  which  he  reported 
a  case  where  he  had  employed  cataphoresis  for  gout,  show- 
ing that  the  current  carries  lithium  salts  into  the  bod}^ 
and  gives  great  relief  to  a  swollen  joint.  His  method  was 
to  put  one  hand  into  a  vessel  containing  a  solution  of 
chloride  of  sodium,  in  which  the  cathode  was  inserted,  and 
the  other  into  a  vessel  containing  chloride  of  lithium,  in 
which  the  anode  was  inserted.  The  lithium  salt  passed 
into  the  body,  being  detected  afterward  in  the  urine. 

As  I  have  previously  stated,  the  action  of  the  currents, 
just  like  that  of  a  magnet,  is  limited  to  their  poles,  and 
there  is  a  middle  line  of  neutrality  between  the  poles. 

Fluids,  therefore,  do  not  pass  entirely  through  the  body 
by  means  of  cataphoresis,  but  having  penetrated  the  tissues 
at  the  poles  they  may  be  absorbed  and  enter  the  general 
circulation,  as  has  been  demonstrated  by  Edison  and 
others. 

Medicines  applied  by  the  active  electrode  directly  oppo- 
site and  in  close  proximity  to  diseased  organs  penetrate 
them  thoroughly,  those  nearest  the  pole  becoming  saturated 
with  the  medicine. 

In  order  to  procure  the  best  results  in  the  way  of  cataph- 
oresis, unoxidizable  electrodes,  as  platinum  or  gold, 
should  be  used;  otherwise  the  electro-negative  elements, 
as  oxygen  and  the  acids,  would  attack  the  metal  and  form 
new  compounds  at  the  anode,  lessening  thereby  the  cataph- 
oric action.  With  reference  to  the  use  of  the  cathode,  it 
does  not  matter  what  metal  is  used,  as  hydrogen  and  the 
alkalies  do  not  combine  with  it.  Electrolysis  and  catapho- 
resis are  always,  to  a  limited  extent  concomitant,  yet  when 
an  electrode  is  used  that  is  not  attacked  by  the  electro- 
negative elements  cataphoresis  is  more  marked. 

Sulphuric,    phosphoric   and   hydrochloric   acids   always 


ELECTRO-PHYSICS.  203 

appear  at  the  anode  when  applied  to  animal  tissue,  though 
the  latter  (hydrochloric  acid)  is  in  greater  abundance. 
There  is  a  tendency  of  the  anode  to  stick  closely  to  animal 
tissues  when  applied  with  an  oxidizable  electrode,  such  as 
copper,  zinc  or  iron.  This  is  due  to  the  action  of  the 
electro-negative  elements  upon  the  metals,  forming  new 
combinations  that  adhere  firmly  to  the  tissue.  In  order 
to  release  the  electrode,  the  current  is  reversed  for  a  few 
minutes,  when  it  again  becomes  loose  and  can  be  with- 
drawn. These  elements  are  somewhat  irritating  to  the 
tissue.  They  sting  to  an  extent  dependent  upon  the 
strength  of  the  current  used,  but  do  not,  as  many  believe, 
burn  or  cauterize  the  parts. 

While  it  is  evident  that  electrolysis  takes  place  in  the 
large  majority  of  remedies  of  multiple  elements  in  the 
process  of  oataphoresis,  yet  some  of  the  medicine  passes 
with  the  flow  of  the  current  without  being  chemically 
changed.  This  is  in  accordance  with  the  law  of  attraction 
and  repulsion  of  atoms  as  induced  by  magneto-electric 
properties — ^that  unlike  attracts  and  like  repels. 

So  complex  are  the  analytic  and  synthetic  changes  that 
occur  in  the  tissues  and  remedies,  as  the  result  of  the 
electrolytic  and  catalytic  actions  of  the  galvanic  current 
upon  them,  that  in  many  instances  it  has  been  only  by 
numerous  experiments  that  I  have  been  able  to  determine 
just  what  chemic  changes  take  place,  and,  in  view  of  these 
changes,  to  select  the  best  remedy  for  certain  conditions 
and  complications. 

In  the  use  of  any  medicine  for  cataphoresis  its  chemic 
elements  should  be  known,  unless  one  decides  upon  a  blind 
experiment  or  groping  in  the  dark. 

Electrolytic  action  may  be  expected,  at  least  to  some 
extent,  and  some  of  the  medicine  used  is  decomposed  into 
its  chemic  elements;    so,  instead  of  getting  the  effect  of 


204  ELECTRO-PHYSICS. 

the  medicine  as  used,  one  gets  that  of  one  or  more  of  its 
chemic  elements.  Let  us  take  iodide  of  potassium  for 
illustration,  it  being  an  electrolyte,  and  suppose  the  active 
electrode  to  be  an  unoxidizable  metal,  as  platinum;  then 
there  could  be  no  chemic  action  upon  the  latter  by  any  oi 
the  elements  set  free  by  electrolysis.  Now  suppose  we  use 
the  cathode  as  the  active  electrode;  the  iodide  of  potas- 
sium would  be  decomposed  into  iodine  and  potassium,  and 
iodine,  being  the  electro-negative  element,  would  tend 
toward  the  anode,  which  would  be  the  indifferent  electrode, 
and  if  the  cathode  is  in  apposition  to  the  prostate  the 
iodine  must  necessarily  pass  through  the  gland  before 
reaching  the  neutral  point  between  the  electrodes.  But 
suppose,  on  the  other  hand,  that  the  anode  is  used  as  the 
active  electrode;  then  the  greater  part  of  the  iodine,  as  a 
result  of  the  electrolytic  action,  would  remain  at  the  pole, 
and  only  a  limited  amount  of  it,  together  with  the  electro- 
negative elements,  as  potassium,  hydrogen,  etc.,  would  be 
diffused  through  the  gland  on  their  way  toward  the  cath- 
ode, and  but  little  change  would  take  place  within  the 
gland  as  a  result  of  interstitial  electrolysis,  by  means  of 
these  elements  alone. 

The  action  of  the  poles  of  the  galvanic  current  does  not 
destroy  tissue  as  does  the  cautery,  unless  the  cautery  cur- 
rent especially  devised  for  that  purpose  is  used ;  but  when 
applied  to  any  part  of  the  tissue,  it  decomposes  it  into  its 
original  chemic  elements.  The  tissue,  possessing  no  longer 
its  normal  anatomical  constituents,  becomes  atrophied,  and 
the  parts  disorganized  are  absorbed,  as  stated  before. 
More  especially  do  these  changes  take  place  in  morbid 
tissue,  defective  in  vital  activity  or  recuperative  power. 

As  water  and  the  chlorides  of  sodium,  potassium,  etc., 
constitute  a  large  part  of  all  tissue,  oxy-chlorides  are  al- 
ways present  at  the  anode  when  galvanic  applications  are 


ELECTRO-PHYSICS. 


205 


Fig.  XXVI. 


'20e  ELECTRO-PHYSICS. 

made;  and,  as  these  constituents  have  a  strong  afimity  for 
metallic  bases,  they  will  attack  any  oxidizable  metal  used 
as  an  electrode  for  thatr  pole,  and  form  new  compounds, 
even  when  medicines  are  not  used.  For  example,  should 
a  solid  copper  electrode  be  applied  to  the  prostatic  urethra, 
the  oxy-chloride  of  copper  results.  I  often  use  this  treat- 
ment, alternating  with  other  remedies,  when  there  is  a 
rebellious  tendency  of  the  parts  to  healing.  In  some  cases 
it  has  an  almost  magical  effect,  when  the  parts  have  re- 
sisted all  other  applications.  If  it  is  used  very  strong  or 
for  a  long  time,  it  causes  a  sensation  of  stinging  or  burning, 
due  to  the  action  of  metallic  electrolysis,  and  not  to  heat 
in  the  electrode,  as  might  appear.  For  there  is  no  eleva- 
tion of  temperature  in  the  electrode. 

It  should  be  remembered  that  the  electrode  thus  used 
will  adhere  tightly  to  the  tissues.  It  should  not  be  forcibly 
removed;  but  when  the  current  is  reversed,  as  before 
stated,  the  electrode  slides  away  with  ease. 

While  a  thorough  knowledge  of  the  properties  and  thera- 
peutic action  of  the  different  electric  currents  are  pre- 
requisite to  successful  treatment  of  the  prostate,  yet  it 
is  impossible  for  one  familiar  with  these  to  procure  satis- 
factory results  without  suitable  apparatus.  Manufacturers 
have  so  vied  with  one  another  in  placing  cheap  electric 
paraphernalia  on  the  market  that  therapeutic  failures  are 
often  traceable  to  trashy  apparatus.  Especially  is  this 
true  since  so  few  ph3'sicians  have  any  knowledge  of  electro- 
physics  and  can  tell  when  a  battery,  coil,  rheostat  or  any 
other  part  of  the  outfit  is  properly  constructed,  but  must 
rely  upon  what  the  manufacturer  tells  them.  Fig.  XXVI. 
illustrates  a  wall  cabinet  for  use  on  the  direct  incandescent 
circuit  that  is  as  near  perfect  as  is  made.  The  resistance 
is  effected  through  metallic  wire  and  not  graphite,  and  it 
is  uniform,  durable  and  reliable.     It  has  a  perfectly  regu- 


ELECTRO-PHYSICS.  207 

lated  galvanic  current,  varying  in  force  from  a  fraction 
of  a  volt  to  any  desired  strength  required,  which  can  also 
be  used  for  lighting  diagnostic  lamps.  It  has  the  primary 
and  secondary  faradic  currents,  galvanic  interrupter,  etc. 
I  have  my  sinusoidal  apparatus  wound  specially  to  order 
in  shunt,  as  before  described. 


CHAPTER   XX. 

The  Uses  of  High  Frequency  and  High  Potential 

Currents   ]n   the   Treatment   op   Prostatic 

Diseases  and  Sequelae. 

In  discussing  this  subject,  I  shall  avoid  all  theoretical 
views,  of  which  there  are  many,  neither  shall  I  tax  ni}' 
readers  with  a  long,  tedious  history  of  its  development  and  ■ 
therapeutic  progress;  but  I  shall  endeavor  to  demonstrate 
its  properties  and  therapeutic  uses  in  as  plain,  practical 
and  concise  manner  as  is  consistent  with  a  clear  elucidation 
of  the  subject. 

The  profession  are  indebted  to  Xikola  Tesla  for  the  dis- 
covery of  this  most  valuable  therapeutic  agent.  It  was  in 
February,  1891,  that  he,  by  certain  multiple  windings, 
charging  and  discharging  of  leyden  jars  by  means  of 
alternating  currents,  was  enabled  to  convert  strong  and 
comparatively  frequent  currents  into  currents  of  extreme 
high  frequency — even  to  ten  thousand  interruptions  per 
second.  He  further  proved  that  it  was  possible  to  transmit 
such  a  current  of  ten  thousand  volts  through  one's  body 
with  impunity.  But  it  remained  for  Oudin,  d'Arsonval, 
Eochefort  and  others  to  take  up  the  current  at  this  stage, 
and  by  means  of  accessories,  by  way  of  resonators,  solenoids, 
condensors,  interrupters,  detonators,  etc.,  they  have  been 
enabled  to  increase  the  interruptions  or  oscillations  and 
tension  of  the  current  to  almost  an  inconceivable  degree: 
so  much  so  that  I  even  hesitate  to  state  that  these  interrup- 
tions or  oscillations  have  been  calculated  above  the  million 
per  second.  In  fact,  the  more  frequent  the  interruptions 
and  the  greater  the  tension  of  the  current,  the  less  danger 

208 


TREATMENT    OF    PROSTATIC    DISEASES.  209 

and  more  soothing  to  the  organs  to  which  applied.  A  cur- 
rent may  be  passed  through  one's  body,  of  such  high  de- 
gree of  tension  as  to  cause  a  brilliant  glow  of  a  sixteen 
candle  power  lamp  held  several  inches  from  the  person, 
without  creating  any  other  sensation  than  that  of  an  exhil- 
arating warmth. 

But  as  I  propose  dealing  only  with  the  practical  consid- 
eration of  the  current  with  reference  to  prostatic  diseases,  I 
shall  refer  those  desirous  of  investigating  along  this  line 
still  further,  to  Freund,  on  High  Frequency  and  Eadio- 
Therapy.  Permit  me  to  caution  those  contemplating  pro- 
curing high  frequency  apparatus,  not  to  be  persuaded  by 
interested  manufacturers  to  get  a  coil  with  spark  less  than 
twelve  inches.  Then  a  good  resonator  with  solenoid  is  in- 
dispensable when  the  tension  and  volume  of  the  current 
may  be  so  modified  as  to  meet  all  therapeutic  indications 
in  so  far  as  the  capability  of  this  current  is  concerned. 
Should  you  have  a  good  static  outfit,  a  resonator  con- 
structed to  use  with  it  will  greatly  enhance  its  value. 

The  fact  that  a  high  frequency  current  brought  in  eon- 
tact  with  morbid  tissue  will  affect  it  is  axiomatic.  There 
are  at  least  three  ways  by  which  change  in  the  tissue  takes 
place.  The  generation  of  ozone  is  unquestioned,  and  its 
effect  toward  converting  an  unhealthy,  ulcerated  surface 
into  a  healthy  one  is  indisputable ;  besides  being  one  of  our 
most  efficient  germicides.  Secondly,  the  rapid  vibrations 
effecting  molecular  disturbance  within  the  tissues  is  evi- 
dent. Tlie  favoring  of  osmosis,  either  by  cataphoresis  oscil- 
lations or  rapid  bombardment  of  the  molecules  of  the  tis- 
sues, is  proven  daily.  Then,  too,  it  does  arouse  to  renewed 
energy  lethargic  organs,  stagnant  circulations  and  devital- 
ized nerves.  It  thereby  fosters  nutrition  and  assists  nature. 
One  of  its  greatest  fortes  is  in  reducing  acute  inflamma- 
tion, allaying  local  irritation  and  congestion,  and,  tbat  it 


210  TREATMENT    OF   PROSTATIC   DISEASES. 


Fig.   XXVII.     (Illustrates  the  coil   used  by  the  author.) 


TREATMENT    OF   PROSTATIC   DISEASES.  21j 


Fig.  XXVIII. 


212  TREATMENT    OP   PROSTATIC   DISEASES. 

dissipates  morbid  tissue  to  a  certain  extent,  I  have  demon- 
strated time  and  again.  It  is  slow  in  its  action  and  takes 
time  and  patience,  as  in  the  majority  of  the  cases,  having 
come  under  my  observation,  have  had  trouble  for  many 
years. 

I  shall  not  attempt  description  of  the  various  types  of 
resonators  and  solenoids  in  common  use,  but  will  give  brief 
outline  of  one  of  the  most  modern  and  convenient  of  which 
I  myself  use.  Fig.  XXVIII.  illustrates  the  apparatus 
devised  by  Oudin,  Dean  and  d'Arsonval: 

(R.  Eesonator)  ;  (S.  Solenoid)  ;  (D.  Detonator  or  spark 
gap) ;  (C.C.  Condensors) ;  (G.  Spring  clip)  ;  (A,  Attach- 
ment of  conducting  cords  (co)  to  resonator) ;  (E.E.  At- 
tachment of  cords  for  free  resonance). 

As  it  is  a  well  known  fact  that  there  are  no  non-con- 
ductors, and  more  especially  with  reference  to  currents  of 
high  frequency  or  high  potential,  yet  glass  or  rubber  is  the 
most  common  of  materials  used  for  insulation.  Glass 
tubes  (Fig.  XXIX.) 


Fig.  XXIX. 

of  partial  vacuum  are  the  only  ones  that  have  been  in  gen- 
eral use  in  the  treatment  of  prostatic  and  vesical  troubles. 
But  as  the  glass  tube  is  equally  conductile  throughout  its 
entire  length,  the  current  intended  to  be  applied  directly  to 
the  prostate  by  means  of  this  tube  is  so  distributed  along 
the  urethral  canal  that  it  has  become  so  exhausted  before 
reaching  the  prostate  that  its  effect  upon  the  gland  or 
vesical  neck  is  quite  limited.    To  obviate  this  waste  and  to 


TREATMENT    OB'  PROSTATIC   DISEASES. 


2U 


concentrate  the  current  upon  the  part  affected^  I  have  con- 
structed an  instrument  (Fig.  XXX.)  that  is  insulated  with 
vulcanized  rubber  throughout  its  course,  except  at  the  cord 
attachment  and  the  other  extremity.  The  current,  obeying 
the  well  known  physical  law  of  passing  where  there  is  the 
least  resistance,  can  be  concentrated  at  any  point  desired 
by  the  operator.  The  instrument  is  also  so  constructed  that 
medicinal  applications  can  be  made  at  the  same  time  the 
current  is  used,  either  to  effect  cataphoresis  or  as  a  simple 
medicinal  application  to  the  diseased  area.  Hence,  by 
means  of  this  electrode,  the  current  as  well  as  the  medicine 
can  be  concentrated  directly  upon  the  gland.  Fig.  XXXI. 
illustrates  the  application  of  the  instrument  directly  to 
the  prostate : 


Fig.   XXX. 


The  method  of  application  I  have  found  most  effectual 
towards  allaying  local  irritation  and  inflammation  of  the 
prostate  by  means  of  this  current,  is  that  of  forced  reson- 
ance of  extreme  high  tension.  This  is  accomplished  by  using 
a  single  insulated  conducting  cord  attached  to  A,  (Fig. 
XXVIII.),  then  connected  to  the  urethral  electrode  and 
with  the  spring  clip  on  the  top  coil  of  the  solenoid  (S.). 
Should  it  be  desirous  to  increase  the  amperage  or  volume  of 
the  current  in  its  application  to  the  gland,  then  the  solenoid 
should  be  interposed  together  with  the  resonator.  This  is 
accomplished  by  lowering  the  spring  clip  (S.)  to  the  mid- 


214  TREATMENT    OF   PROSTATIC   DISEASES. 


Fig.   XXXI. 


THE    TREATMENT    OF    STRICTURE.  215 

die  or  lower  coil  of  the  solenoid.  This  last  application  is 
more  efficient  in  reducing  or  softening  an  indurated  gland ; 
then,  too,  for  destro}'ing  large  vegetative  growths.  But  it 
should  not  be  used  until  local  irritation  and  inflammation 
should  be  first  allayed,  as  before  mentioned,  when  it  can 
be  instituted  with  impunity. 

The  application  by  free  resonance  is  effected  by  attaching 
one  of  the  cords  to  binding  post  (E.),  then  to  the  electrode 
in  application  to  the  patient,  with  another  cord  passing 
from  the  other  binding  post  (E.)  and  grounded;  or  in 
direct  application  to  the  patient's  body  with  very  large  and 
very  wet  electrode.  Should  this  not  be  very  carefully  ob- 
served the  patient  may  be  burned  very  severely. 

The  current  is  also  used  in  application  to  the  prostate 
through  the  rectum,  just  as  the  other  currents  as  heretofore 
described. 

In  further  consideration  of  the  utility  of  the  high  fre- 
quency current,  I  shall  give  briefly  the  results  of  my  ex- 
perience with  it  during  the  past  few  years. 

In  the  first  place,  when  used  in  connection  with  the 
resonator  and  short  detonator,  it  is  one  of  the  most  positive 
analgesics  we  have.  Its  relief  of  pain  is  effected  by  toning 
up  the  nerves  involved,  instead  of  depressing  them,  as  is 
the  case  with  most  all  other  anodynes.  Another  com- 
mendable property  of  this  current  is,  that  it  is  far  reaching 
and  penetrates  the  deep  tissues  that  are  inaccessible  to 
other  means,  except  those  given  constitutionally,  with 
their  disturbing  influence  upon  the  system.  It,  at  the 
same  time,  generates  ozone,  a  most  active  local  bactericide, 
besides  being  a  marked  tonic  to  the  lungs  and  the  system 
in  general,  and  especially  to  the  nerves  throughout  the 
body.  It  is  a  well  known  fact  that  pain  alone  will  per- 
petuate irritation  and  inflammation,  and  the  relief  af- 
forded by  this  current  during  the  course  of  treatment  of 
these  tender  organs,  not  only  adds  comfort  to  the  patient, 


216 


THE  TREATMENT  OF  STRICTURE. 


but  materially  hastens  the  progress  of  the  treatment. 

I  herewith  append  some  very  interesting  and  edifying 
experiments  made  upon  hay  infusoria  with  the  high  fre- 
quency current;  in  comparison  with  the  other  different  elec- 
tric currents. 

•'m> s^ 


Fig.  XXXIIe  illustrates  two  glass  slides  which  are  sep- 
arated two  centimeters  by  means  of  soft  rubber  around  the 
edges  and  ends.  On  the  inside  of  the  rubber  at  each  end 
nonoxidizable  pieces  of  metal  are  so  arranged  that  cord- 
tips  (+j  — )  are  attached  thereto.  The  space  between  the 
slides  is  filled  with  a  solution  containing  the  infusoria. 

Fig.  XXXIIc. 

My  first  experiment  was  to  transmit  a  mild  galvanic  cur- 
rent through  the  fluid,  when  the  germs  would  immediately 
pass  from  the  positive  (  +  )  to  the  negative  ( — )  pole. 
The  current  was  then  suddenly  reversed,  when  the  germs 
would  at  once  turn  and  move  to  the  opposite  pole.  A 
strong  current  would  cause  them  to  move  more  rapidly. 
On  breaking  the  circuit  they  would  be  slowly  diffused 
through  the  fluid  again.  After  a  few  experiments  of 
reversing  the  currents  of  from  one  to  three  minutes'  dura* 
tion,  the  germs  became  very  sluggish. 

The  sinusoidal  current  was  then  tried  upon  a  fresh  sup- 
ply of  infusoria,  when  they  would  undergo  very  rapid  oscil- 
lations, but  would  not  move  towards  either  pole.  The  oscil- 
lations of  the  germs  were  evidently  due  to  the  effect  of 
magnetizing  and  demagnetizing  of  them  by  the  rapid  alter- 
nations of  the  current.  The  circuit  was  allowed  to  remain 
closed  for  five  minutes,  when  many  of  the  germs  became 
inactive  and  the  others  sluggish.     The  circuit  was  then 


THE  TREATMENT  OF  STRICTURE.  217 

closed  for  ten  minutes,  when  more  than  half  of  the  in- 
fusoria were  non-motile. 

The  primary  and  secondary  faradic  currents  were  tried 
successively  upon  fresh  supplies  of  the  same  fluid.  The 
result  was  that  little  or  no  eflEect  upon  the  germs  was  pro- 
duced, until  the  current  was  used  too  strong  to  be  safe  or 
harmless  if  applied  to  an  individual. 

Clinically,  I  have  found  the  sinusoidal  current  excep- 
tionally beneficial  in  gonorrheal  vesiculitis,  when  applied, 
with  from  ten  to  fifteen  thousand  ohms  resistance,  through 
the  rectum.  The  influence  of  the  galvanic  current  is  best 
exerted  through  the  prostatic  urethra,  after  the  subsidence 
of  all  acute  symptoms,  and  should  not  be  used  before. 

The  high  frequency  current  was  used  with  fresh  germs 
when  they  became  paralyzed  or  immobile  within  ten  sec- 
onds of  the  passage  of  the  current.  This  current  can  be 
used  either  in  the  rectum  or  urethra  with  impunity. 

The  Treatment  of  Stricture  of  the  Urethra  bi 
Electrolysis. 

As  stricture  of  the  urethra  is  one  of  the  frequent  com- 
plications of  prostatic  troubles,  I  shall  append  hereto  a 
brief  outline  of  its  proper  treatment. 

^  Conservative  surgeons  have  always  advised  dilatation  as 
the  first  mode  of  procedure,  since,  if  properly  used,  there 
is  much  less  danger  than  by  incision  or  divulsion.  But 
dilatation  is  limited  in  its  action,  and  is  generally  prac- 
tised for  only  temporary  relief. 

One  of  the  most  essential  requisites  before  the  use  of 
electrolysis  is  to  prepare  each  case  properly  before  attempt- 
ing the  operation.  Individual  oases  vary  so  much  in  regard 
to  tenderness,  irritation,  amount  of  granulation,  consist- 
ence, and  length  of  existence,  that  it  requires  considerable 


218  THE    TREATMENT    OF    STRICTURE, 

experience  to  decide  liow  to  jDrepare  and  when  to  begin 
operation. 

As  I  have  heretofore  described  in  detail  the  methods  of 
allaying  local  irritation  and  inflammation  of  the  urethra,  I 
shall  refer  my  readers  to  the  chapter  on  that  subject.  The 
technique  of  the  operation  is  as  follows:  A  large  sponge 
or  carbon  electrode,  being  attached  to  the  cord,  which  is 
previously  fastened  to  the  anode  of  the  battery,  is  placed 
within  easy  access  of  the  patient.  The  minimum  strength 
of  the  current  is  then  interposed  in  the  circuit,  and  the 
urethral  electrode,  being  attached  to  the  cord  from  the 
cathode,  is  passed  down  to  the  stricture.     (See  Fig.  xxxii.) 

The  patient  then  takes  up  the  large  electrode  and  holds 
it  firmly  in  his  hands.  The  current  can  be  increased  grad- 
ually to  the  desired  strength  without  interrupting  its  flow. 

The  susceptibility  of  individual  cases  varies  so  greatly 
that  I  would  always  advise  the  use  of  the  mildest  current 
and  the  shortest  duration  in  the  first  few  treatments. 
Whenever  there  is  indication  of  pain,  it  should  be  discon- 
tinued at  once.  I  seldom  use  local  anaesthesia,  not  even 
in  nervous  patients  with  excessively  hyper-aesthetic  ure- 
thras. The  sensation  is  one  of  the  best  guides  to  the  foroe 
of  the  current  used  and  the  length  of  time  it  is  to  be  con- 
tinued. It  must  be  remembered  that  the  current  can  be 
used  longer  and  stronger  near  the  meatus  than  in  the  lower 
urethra.  The  farther  you  recede  from  the  meatus,  in* 
direct  proportion  thereto  must  caution  be  used. 

The  removal  of  the  electrode  from  the  urethra  must  be 
accomplished  in  the  same  way  as  its  introduction.  The 
patient  must  put  aside  the  hand  electrode,  or  catch  it  by 
the  insulated  handle,  when  the  urethral  electrode  can  be 
withdrawn  without  shock  or  pain.  If  this  precaution  is  not 
followed  and  a  shock  is  given,  the  patient  never  forgets  it. 


THE    TREATMENT    OF    STRICTURE. 


219 


and  will  always  be  nervous  and  uneasy  at  each  successive 
treatment. 

I  usually  begin  with  a  current  strength  of  three  milli- 
amperes,  of  from  two  to  three  minutes'  duration.  Should 
it  not  be  followed  by  any  local  irritation,  or  but  very  little, 
it  could  be  increased  at  the  next  treatment  to  five  or  six 
milliamperes,  and  for  five  minutes.  In  some  callous  cases 
I  have  used  a  current  strength  of  ten  to  fifteen  milli- 


Fig.   XXXII. 

amperes,  should  it  not  be  attended  with  pain  or  hemor- 
rhage. 

Fig  XXXII.  illustrates  the  author's  method  of  removal 
of  stricture  by  electrolysis. 

Eectal  ulceration  on  its  anterior  surface,  and  from  one 
to  two  inches  within  the  anus  (as  L),  is  common;  and  lying 
in  close  proximity  and  opposite  the  prostate,  aggravates 


220  TUE    TREATMENT    OF    STRICTURE. 

any  inflammatory  condition  of  the  latter.  I  have  occa- 
sionally met  with  ulceration  high  up  in  the  rectum  (as  H). 
Such  ulcers  may  have  heen  present  for  a  long  time  with 
little  or  no  subjective  symptoms  being  manifest.  Ulcers 
in  the  lower  part  of  the  rectum  are  generally  attended 
with  constipation,  owing  to  reilex  contraction  of  the 
sphincters  that  they  induce.  When  such  ulcer  exists,  it  is 
almost  impossible  to  relieve  prostatic  irritation  without 
first  relieving  the  ulcer. 

I  usually  make  my  applications  about  every  five  or  six 
days,  but  am  governed,  of  course,  by  conditions  and  com- 
plications that  may  arise.  I  never  use  now,  an  electrode 
smaller  than  No.  14  or  16  French,  as  it  is  liable  to  be 
passed  into  the  orifice  of  a  lacunae  or  caught  in  a  fold  in 
front  of  a  stricture  and  cause  a  false  passage.  This  pre- 
caution should  especially  be  observed  by  a  neophyte.  A 
large  electrode  will  decompose  and  enter  a  stricture  more 
satisfactorily  than  a  small  one,  and  with  less  pain.  A 
small  one  is  more  liable  to  cause  some  trouble,  and  espe- 
cially in  the  membranous  or  prostatic  urethra.  I  have 
often  treated  strictures,  even  in  the  deep  urethra,  so  con- 
tracted as  not  to  admit  the  passage  of  the  smallest  size 
bougie,  and  where  the  urine  would  only  pass  in  drops; 
when,  on  the  second  or  third  day  after  the  electric  treat- 
ment, and,  too,  without  passing  the  stricture  with  the  elec- 
trode, the  urine  would  suddenly  burst  out  in  a  bold  stream, 
preceded  by  the  forcible  ejection  of  a  plug  of  the  strictural 
mass,  which  had  evidently  been  detached  by  the  effect  of 
the  current.  At  times  this  has  occurred  after  the  first 
treatment,  though  generally  after  the  second  or  third. 

I  pass  a  bougie  once  or  twice  between  each  electric  treat- 
ment, and  never  use  one  that  does  not  pass  easily  and 
without  force.  Some  speak  of  the  treatment  as  cauterizino; 
or  burning  out  the  stricture.     There  is  no  heat,  not  the 


THE    TREATMENT    OP    STRICTURE.  221 

slightest  elevation  of  temperature  in  the  electrode;  hence 
there  could  be  no  cautery  or  burning.  The  process  is  one 
solely  of  chemical  decomposition  and  disintegration  of  the 
strictured  mass,  which  passes  off  as  gases,  discharges  and 
even  at  times  of  large  particles  of  the  strictured  mass  itself. 


A  FEW  CASES. 

I  hereby  append  a  few  cases  that  recently  came  under 
my  observation. 

Case  XXXVI. — Single;  Age  27;  Chronic  Prostatic 
Urethritis,  Vesiculitis^  Metastasis. 

The  most  prominent  symptom  with  which  this  man  suf- 
fered was  that  of  weekly  exacerbations  of  excessive  pain  in 
the  right  side,  in  the  hypochondriac  region.  These  attacks 
were  attended  with  slight  pj^rexia.  The  temperature  often 
reached  101  and,  occasionally,  102  F.,  in  the  evening.  He 
had  been  suffering  with  these  attacks  for  about  eighteen 
months  before  consulting  me.  At  first  the  paroxysms  were 
mild,  lasting  one  or  two  days,  and  passing  off  with  little 
systematic  disturbance,  recurring  the  second  and,  occasion- 
all}'',  the  third  week.  These  grew  more  frequent  and  severe 
in  type,  until,  as  before  stated,  he  was  having  them  weekly. 
He  had  had  gonorrhea,  at  the  age  of  20,  six  years  before. 
Up  to  that  time  he  had  been  in  fairly  good  health,  and  had 
apparent!}^  recovered  from  gonorrhea  and  there  were  not 
even  any  indications  of  gleet.  These  exacerbations  had 
been  attended  with  a  low  form  of  fever,  which  would  last 
from  two  to  three  and,  occasionally,  four  days.  His  physi- 
cian would  give  him  some  antipyretic  and  a  good  purga- 
tive, when  he  would  slowly  recover.  Before  recuperating 
from  one  attack  he  would  have  a  second,  and  so  on,  keeping 
him  constantly  in  a  state  of  depression,  and  unable  to  at- 
tend to  business.  His  ailment  had  been  diagnosed  as  vari- 
ous troubles,  all  except  appendicitis,  and  it  is  strange  that 
no  one  had  diagnosed  it  that. 

An  examination  revealed  an  inflammatory  condition  of 


222  THE  TREATMENT  OF  STRICTURE. 

the  prostatic  urethra,  as  well  as  the  vesicles.  The  gland 
was  slightly  swollen.  The  secretions  contained  columnar 
cells,  mucous  and  dead  cocci. 

The  prostatic  urethra  being  extremely  sensitive,  the 
treatment  consisted  in  an  application  of  flexible  bougies 
with  benzoinol  ointment  to  the  prostatic  urethra  on  alter- 
nate days.  He  was  also  treated  on  the  second  day  with  a 
mild  mechanical  massage  to  the  seminal  vesicles  through 
the  rectum.  No  electric  current  was  used.  At  the  expira- 
tion of  one  week,  instillation  was  made  to  the  deep  urethra 
by  means  of  my  electrode  applicator,  of  1  per  cent  sol.  of 
thallin  sul.  After  the  second  week  the  high  frequency  cur- 
rent was  added  thereto.  Two  weeks  after  beginning  treat- 
ment he  had  a  slight  return  of  his  pain  in  the  side,  with 
slight  pyrexia,  remaining  home  only  one  day.  The  treat- 
ment was  continued  regularly,  alternating  one  day  through 
the  rectum,  and  the  second  day  through  the  urethra,  when 
there  was  complete  subsidence  of  these  pains,  and  a  grad- 
ual restoration  to  perfect  health. 

This  case  is  well  authenticated,  as  it  has  been,  and  is 
even  now,  under  the  observation  of  several  prominent  physi- 
cians of  this  city. 

The  rationale  of  the  treatment  in  this  case  was  unques- 
tionably exemplified  in  the  arrest  of  the  source  of  the  in- 
fection by  destroying  the  cocci  hidden  within  the  prostate 
and  vesicles,  and  which  were  inaccessible  by  any  other 
means. 

Case  XXXVII. — History:  Age  51;  Married;  Chronic 

Prostatitis,  Cystitis,  Vesiculitis,  Gonorrheal 

Metastasis. 

Contracted  conorrhea  at  the  age  of  26,  which  lasted  him 
six  months,  and  was  followed  with  acute  prostatitis,  ure- 
thritis, cystitis.  He  suffered  with  periodical  exacerbations 
for  three  years,  subsiding  in  a  form  of  gleet,  from  which 


THE  TREATMENT  OF  STRICTURE.  223 

he  occasionally  had  symptoms  of  a  slight  discharge,  or 
gluing  together  of  the  meatus.  There  were  no  marked 
indications  of  prostatitis,  inflammation  of  the  bladder,  or 
any  other  trouble,  until  in  his  forty-fifth .  year,  when  he 
began  having  attacks,  of  what  he  called  rheumatism,  in  hig 
shoulders  and  back  of  neck,  and  occasionally  in  his  back. 
There  was  an  impairment  of  his  left  limb,  by  way  of  a 
heaviness,  which  necessitated  a  dragging  of  this  limb,  and 
he  was  unable  to  lift  it  as  easily  as  the  other.  Some  days 
it  would  be  better,  other  days  worse.  Otherwise,  health. 
good.  He  was  an  active  business  man.  Two  j^ears  prior 
hereto  he  began  to  have  excessive  pains  in  back  of  neck  and 
shoulders,  extending  to  his  fingers.  Occasionally  there 
would  be  a  tingling  sensation  down  the  arm  to  the  fingers, 
and  he  was  unable  to  hold  a  pen  to  write.  He  noticed, 
about  this  time,  too,  that  he  was  unable  to  shave  himself. 
The  pain  grew  so  intense  in  back  of  neck  that  he  could  not 
sit  in  a  barber's  chair,  with  any  degree  of  comfort,  to  be 
shaven.  His  digestion  was  good,  bowels  regular,  weight 
normal,  and  usually  slept  well.  He  had  been  treated  by 
some  of  the  best  physicians,  with  various  kinds  of  medica- 
tion, including  the  different  preparations  of  coal  tar, 
salicilates,  etc.  In  fact,  he  had  taken  medicines  from 
physicians  who  knew  as  much,  or  more,  than  I,  for  the 
relief  of  these  troubles.  He  had  been  treated  by  a  nerve 
specialist,  who  applied  electric  currents  to  his  spine,  limbs 
and  arms.  At  times  this  was  followed  with  temporary 
relief,  yet  each  month,  for  a  year,  he  had  noticed  he  was 
worse  than  the  previous  one. 

An  examination  revealed  cystitis,  prostatitis  and  vesiculi- 
tis of  chronic  nature.  The  gland  was  somewhat  enlarged — 
swollen — from  long  standing  low  ffrade  of  inflammation. 
There  was  no  acute  tenderness  of  the  parts,  but  a  cellular 
infiltration  of  the  rectal-mucosa  in  the  region  nf  the  pros- 
tate and  vesicles. 

Chemical  and  microscopical  examination  of  the  urine 


224  THE  TREATMENT  OF  STRICTURE. 

and  prostatic  secretions  revealed  epithelial  cells  of 
squamous  and  columar  variety,  also  debris  of  cocci,  which 
indicated  additional  involvement  of  the  bladder,  prostate 
and  seminal  vesicles. 

My  treatment  consisted  at  first  in  local  applications  of 
argyrol  to  the  prostatic  urethra,  by  means  of  my  urethral 
electrode  applicator,  using  a  3  per  cent  sol.  This  was 
alternated  on  the  second  day  with  an  application  of  a  2 
per  cent  solution  of  picratol  to  the  rectum.  This  treatment 
was  continued  for  one  week,  and  upon  the  subsidence  of 
all  acute  symptoms  I  began  giving  the  high  frequency  cur- 
rent, through  the  prostatic  urethra,  by  means  of  the  same 
insulated  electrode  applicator.  On  the  second  day  I  used 
vibratory  massage,  through  the  rectum,  applying  this  first 
to  the  prostatic  portion,  then  extending  gradually  up  to 
the  vesicles.  These  vibratory  applications  were  given  very 
cautiously  at  first,  not  permitting  the  instrument  to  come 
in  contact  with  the  front  surface  of  the  rectum  against  the 
prostate  or  vesicles.  These  were  modified,  also,  in  their 
frequency,  and  the  vibrations  were  given  about  4,000  to 
5,000  per  minute.  All  systematic  medication  was  dis- 
continued. Improvement  began  at  once,  and  from  day  to 
day  it  was  most  marked.  After  the  expiration  of  two 
weeks  the  sinusoidal  current  was  attached  to  the  vibratory 
rectal  electrode.  Occasionally  I  alternated  with  the  gal- 
vanic application  through  the  prostatic  urethra,  with  a 
view  of  effecting  by  cataphoresis  the  stimulating  of  absorp- 
tion and  diminishing  the  size  of  the  swollen  gland.  As  be- 
fore stated,  I  gave  little  or  no  internal  medicine,  as  he  had 
taken  for  years  and  j^ears  from  men  equally  as  competent, 
or  more  so,  than  I,  that  method  of  treatment.  I  could  only 
see  one  indication  for  treatment — which  was  to  destroy  the 
source  of  the  infection,  remove  morbid  conditions,  and 
nature  would  do  the  balance,  which  it  did  very  effectually 
in  this  case.     At  the  expiration  of  three  months'  time  he 


THE  TREATMENT  OF  STRICTURE.  225 

did  not  have  a  pain,  and  the  only  symptom  that  still  lin- 
gered was  an  occasional  tingling  of  one  of  his  fingers. 

At  the  expiration  of  six  months,  although  he  had  dis- 
continued treatment  three  months  prior  thereto,  I  again 
saw  him,  and  he  reported  that  he  was  entirely  well,  and 
had  no  occasion  to  call  upon  a  physician  except  socially. 

The  result  of  treatment  of  this  case  incontestably  demon- 
strated that  the  poisons  thrown  off  by  the  pent-up  cocci 
were  absorbed  and  transmitted  to  remote  parts  of  the  body, 
where  they  exerted  a  baleful  influence  upon  the  sheaths  of 
the  nerves  and  the  serous  membranes.  These  tissues  seem 
to  be  the  special  targets  of  attack  by  this  virus. 

Case  XXXVIII. — Age  30;  Married;  Chronic  Prostati- 
tis, Cystitis,  Abscess  of  Prostate,  Metas- 
tasis, Etc. 

At  the  age  of  20  contracted  gonorrhea,  which  lasted  eiglit 
months,  during  which  time  the  inflammation  was  excessive. 
He  was  treated  both  locally  and  constitutionally.  This 
was  followed  by  gleet,  which  was  continuous  for  two  years 
thereafter,  when  he  had  a  second  attack  of  acute  gonorrhea. 
This  latter  lasted  about  eighteen  months.  The  inflam- 
matory condition  was  exceedingly  severe,  and  was  followed 
by  gonorrheal  rheumatism,  cystitis,  chronic  inflammation 
of  the  prostatic  urethra,  prostatitis,  and  an  abscess,  rup- 
turing into  the  prostatic  urethra.  The  inflammatory  con- 
dition extended  from  the  meatus  to  the  neck  of  the  bladder. 
Besides  various  local  applications  to  the  urethra,  and  con- 
stitutional remedies,  he  was  operated  upon  at  three  dif- 
ferent times,  two  of  which  left  fistulous  openings;  one  at 
one-half  inch  and  second  at  an  inch  from  the  glans.  Sub- 
sequently a  perineal  operation  was  made  for  drainage,  of 
eight  weeks'  duration,  with  a  view  of  closing  the  fistulse. 
This  was  a  failure,  and  the  openings  remained  patulous. 
Two  years  later,  the  old  perineal  incisions  opened,  and  for 


226  THE  TREATMENT  OF  STRICTURE. 

a  few  weeks  he  suffered  with  an  acute  attack  of  prostatic 
urethritis,  prostatitis  and  cj'stitis,  with  profuse  discharge 
through  the  perineal  opening  and  the  urethra.  This  dis- 
charge resisted  all  local  and  constitutional  treatment  by 
the  best  physicians  of  Indianapolis  and  Xew  York  for  three 
or  four  A'ears,  when  he  fell  into  my  hands  on  the  26th  day 
of  February,  1905. 

Treatment  was  instituted  with  a  view  of  reducing  local 
inflammation  of  these  various  organs — urethra,  prostate, 
bladder,  rectum  and  vesicles — first  by  means  of  irrigation, 
using  from  1  per  cent  to  3  per  cent  of  argyrol.  Subse- 
quently, argyrol  was  changed  for  picratol,  using  from  one- 
fourth  to  1  per  cent  strength.  Applications  of  high  fre- 
quency currents  were  applied  over  the  region  of  the  bladder 
and  perineum,  with  a  view  of  relieving  local  irritation  and 
tenderness  of  these  parts.  This  method  of  treatment  was 
continued  for  three  weeks  before  instrumentation  was  at- 
tempted. Local  applications,  through  the  applicator,  di- 
rectly to  the  prostatic  urethra,  prostate  and  neck  of  bladder, 
were  then  made,  using,  at  the  same  time,  the  high  fre- 
quency current.  These  applications  were  made  two  or 
three  times  per  week,  depending  upon  the  amount  of  irri- 
tation caused  by  the  instruments.  Eelief  followed  each 
treatment  after  the  second  day.  The  first  day  succeeding 
the  operation  there  was  considerable  irritation,  but  the 
benefit  derived  in  two  or  three  days  more  than  counter- 
acted the  ill  effect  of  the  treatment.  I  was  careful  to  note 
that  the .  credit  side  of  the  treatment  more  than  counter- 
balanced the  ill  effect  of  instrumentation.  These  were  the 
conditions  for  some  two  months  before  any  marked  subsi- 
dence of  inflammation  of  these  organs,  and  also  of  the 
urethral  discharge,  were  noticeable,  but  the  patient  was 
comparatively  comfortable.  When  treatment  was  first  in- 
stituted, the  urine  could  not  be  retained  longer  than  from 
30  minutes  to  1^  hours,  and  retention  was  accompanied  by 


THE  TREATMENT  OF  STRICTURE.  227 

considerable  tenesmus.  At  the  expiration  of  two  months 
he  could  go  from  two  to  three  hours  during  the  da}^,  and 
from  four  to  five  hours  during  the  night,  without  voiding 
urine.  At  this  time,  cataphoresis,  by  means  of  both  gal- 
vanic and  high  frequency  currents,  were  applied  from  three 
to  four  times  a  week.  There  was  gradually  a  subsidence 
of  all  infln  mmation,  and  the  urethral  discharge  had  become 
almost  imperceptible.  Improvement  in  every  respect  was 
very  marked.  Complete  cure  was  effected  at  the  expira- 
tion of  nine  months,  except  the  fistulous  openings  re- 
mained patulous. 

Case  XXXIX. — Married;  Age  56;  Chronic  Prostitis 

AND  Vegetative  Growth  at  Xeck  of  Bladder; 

Profuse  Hemorrhage  of  Bladder. 

This  man  had  been  suffering  with  frequency  of  voiding 
urine  for  three  years  prior  to  seeing  me.  It  first  came  on 
in  a  mild  form,  with  occasional  exacerbations.  Finally,  he 
consulted  a  physician,  who  was  very  prominent,  highly 
educated,  and  thoroughly  well  up  in  his  business,  except 
in  the  treatment  of  this  special  trouble.  He  began  using 
sounds,  gradually  enlarging  them  until  he  reached  26  F. 
He  seemed  to  improve  some  after  the  acute  symptoms  had 
been  allayed  by  this  treatment.  On  ISTovember  4,  after 
having  had  his  usual  treatment  with  the  introduction  of 
the  sound,  he  noticed  that  he  was  passing  blood.  He  went 
to  see  his  physician,  and  found  that  the  bladder  was  prac- 
tically filled  with  blood.  He  began  means  of  stopping  it 
by  astringent  irrigations,  but  was  unable  to  control  the 
hemorrhage,  and  the  patient  was  sent  to  me  for  treatment. 
On  arriving,  I  found  the  bladder  distended  and  filled  with 
clotted  blood.  The  patient  was  very  pale  and  very  weak 
from  the  effect  of  the  loss  of  so  much  blood.  I  immedi- 
ately evacuated  the  bladder,  taking  two  hours  to  accom- 
plish it.     During  this  time  there  was  constant  hemorrhage. 


228  THE  TREATMENT  OF  STRICTURE. 

which  necessitated  my  entering  the  bladder  with  a  cysto- 
scope  to  obtain  the  source.  I  found  a  vegetative  growth 
attached  immediately  to  the  back  of  the  prostate.  This 
was  bleeding  very  profusely.  I  then  used  a  cautery,  as  il- 
lustrated on  page  136,  and  stopped  the  hemorrhage.  This 
cautery  application  was  made  every  third  day  to  the  vegeta- 
tive growth  until  completely  destroyed,  leaving  a  very  small 
pedicle.  Treatment  of  the  prostate  was  continued  at  irreg- 
ular intervals  for  two  months,  when  the  patient  was  dis- 
charged. He  left  and  was  gone  four  months,  when  he 
again  returned,  having  a  slight  hemorrhage.  Cystoscopic 
examination  revealed  another  vegetative  growth,  small  in 
size,  attached  to  the  prostate,  by  the  side  of  the  former 
pedicle.  Two  applications  to  this  stopped  the  hemorrhage, 
and  he  has  had  no  trouble  since,  is  in  good  health,  and  is 
now  doing  active  hard  work. 

There  is  no  question  in  the  world  but  that  the  man 
would  have  died  from  hemorrhage  had  it  not  been  con- 
trolled in  the  manner  in  which  it  was,  and  the  only  other 
means  whereby  the  hemorrhage  could  have  been  controlled 
would  have  been  a  serious  operation  that  would  most  prob- 
ably have  cost  the  man  his  life. 


ir<i3E:?c. 

• 

A. 

Abrasion    of    urethral    mucosa 29,  30,     50 

Abscess  of  kidney 92 

Age— in   hypertrophy    113,    114,    118 

Alcoholic  stimulants — causes  of  prostatitis 38,  77,  78 

Forbidden    64,     94 

Amperage    156 

Ampulla    16,     24 

Anatomy — of  bladder 16 

Of  prostate  11 

Anesthesia,  local    61,  134,  141 

Anodynes  22 

Aphrodisiacs 72,   79,   154,  168 

Arteries — prostate 16 

Arthritis   29,  32,  108 

Asepsis — of  urine    38,     75 

Aspermatism   145,  146 

Atony  of  gland 48 

Azoospermia  167 

B. 
Batteries  176,  183  et  seq. 

Construction     of    189 

Baumgarten  27,     29 

Beer — Cause  of  prostatitis  .' 38,     77 

Prohibited 94 

Bicycle  riding  as  a  cause  of  prostatitis 36,     79 

Bladder 14,  37,  50,  74,  79,  80,  81,  82,  83,  84,  85,  109 

Bochart's  theory  on  metastasis ^ 29 

Bottcher's  crystals  85,  119,  167 

Bottini  cautery 109,  110,  111,  121,  122 

Dangers  of 122,  123,  128,  129,  130,  131 

Bougie 53,  61,  62,  63,     69 

Bougie  a  boule 43,  49,  65,     72 

Bowels — relation   to   prostate 16,     17 

Bumm   27,     29 


li  INDEX. 

C. 

Calculi— prostatic 85,  86,  87,  145,  146,  167 

Renal    86 

Vesicle  86,  111,  120 

Caput  gallinaginis  14 

Castration 78,  121,  125,  160 

Cataphoresis 54,  201,  202  et  seq. 

Catheter  life 118,  123,  126,  127,  139,  140,  141 

Cautery— Bottini.  .109,  110,  111,  121,  122,  123,  128,  129,  130,  131 

Galvano  79,  122,  142 

Paquelin's   121 

Circumcision    70 

Cocaine 134 

Cold — effect  on  diseases  of  prostate 36,     79 

Conduction  181,  182 

Congestion — venous  stasis. 

Of  prostate 34,  37,  38,  50,  64,  76,  78,  82,  113 

Of  vesicles  35,     37 

Constipation  117,  141,  160 

Continence 37 

111  effects  of 34,     71 

Cowper's  glands 14,     16 

Currents — applications  of  192 

Chemic  action  of 197 

Faradic 74,  96,  97,  103,  105,  110,  176,  191 

Galvanic    175,  176,  186 

Ignorance  of    177 

Intensity 175,  187 

Physiological  effects  of 193 

Polar   effects   of    59,  199 

Properties  of   57 

Quantity 187 

Sinusoidal    176,  197 

Study   of    .* 176,  177 

Units  of  measurement 192 

Cystoscope — description   of 44 

Use  of 44,  58,   74,  106,  120,  135 

D. 

Desiccation — of  discharge 33,  41,     50 

Of  gonococci    28 

Diet  22,     94 


INDEX.  jii 

Diplococci — resembling  gonococci  27,  30,  32 

Discharge— gleety 23,  39,  41,  50,  57,  64,  67,  73,  78 

Milky  45,  48,  57 

Muco-purulent 18,  51,  64,  67,  83,  93,  135 

Of  prostate  and  vesicles,  irritative  to  urethra.. 40,  41,  43 

Presence  of  gonococci 30,  33 

Prostatic  mistaken  for  seminal 67 

Dysuria 21,  39,  51,  64,  73 

E. 

Ejection,  premature   48,     67 

Electricity  (see  Currents). 

Electrical  potential   178 

Electric  treatment — Technique  of 59,  60,     61 

Frequency  of  61 

Electrodes— Active    61,  62,  88,     94 

Carbon  59 

Metals  used  in 203,  204,  205,  206 

Non-oxidizable    56,     58 

Oxidizable    56,     58 

Special 77,  133 

Electrolysis  201 

Electro-physics    59,  175,  181 

Electro-therapy — Ignorance  of  176 

Study  of   175 

Emission  48,  164,  170 

Epididymis    ; 24 

Inflammation  of  58 

Epilepsy   69,     70 

Epithelium — In  urine  85 

Normal  abode  of  gonococci 29,     30 

Erethism  37,  38,     33 

Erotic  excitement — 111  results  of 35 

Eucalyptol    53,     65 

Examinations  of  rectum — ^With  sigmoidoscope 44,  82,     96 

Examinations  of  urethra — With  bougie  a  houle 42,  49,  65 

With  cystoscope   and   urethroscope 72,   102,  110,  120 

With  sigmoidoscope    82 

Expressions,  prostatic 29,  32,  105 

Eyes — Involved  in  prostatitis 39 

F. 
Faradic  Current  176,  191  et  seq. 


iv  INDEX. 

Follicles — Chronic   catarrh  of 50 

Inflammation  of 50,  53 

Prostatic 16,  24,  29,  62,  85,  88 

Fossa  Navicularis — Ulceration  in 65,  83 

Frequent  urination 21,  81,  105,  108,  109,  111,  113 

Fuller  40 

Functions — Of  prostate    18 

Of  prostatic  fluid 19 

Functional  disorders— Of  bladder 19 

Of  liver 89,  90 

Of  prostate  19 

Of  rectum  19 

Of  seminal  vesicles 19 

Furbringer's  theory  on  metastasis   29 

G. 

Galvanic  current  175,  186 

Cells    184 

Poles  of  198 

Genital  electrode    101 

Gerbardt's  theory  on  metastasis 29 

Gland  (see  Prostate). 

Gleet 22,  39,  40,  50,  64,  66,  73,  80,  104,  146 

Gonococcus 26,  27,  28,  29,  30,  32,  101,  104 

Latent 29,  30,  31,  32,  80,  101,  119,  150 

Gonorrhea — As  cause  of  prostatitis 

26,  64,  66,  73,  77,  104,  105,  108,  112,  113 

Chronic  27,     28 

Gonorrheal  rheumatism .' 26,  29,     80 

Late  theories  as  to  cause 29 

Old  theories  as  to  cause 26 

Granular  patches   43,  55,     72 

As  cause  of  gleet 39 

In  chronic  prostatitis 49,  66,  67,     73 

Removal  of 56,  61,     62 

Guerin's  theory  on  rheumatism 26 

Guyon's  theory   on   metastasis 29 

Guyon's  theory  on  rheumatism 26 

H. 

High  frequency 208,   219 

Hamamelis— In  orchitis    23,  144 

Hartley's  theory  on  metastasis 29 

Hemiparesis 156,  172 


INDEX.  T 

Hemorrhage.,.,,.. 80,  106,  109,  111,  140 

Hemorrhoids  , 26,  117 

Horseback  riding  as  cause  of  prostatitis 36,  79,  138 

Hyoscyamus 22,  51,  107,  110 

Hyperemia  of  prostate  following  excesses 34,     37 

Hypertrophy— Author's  treatment 126,  127,  128 

Senile 24,  76,  82,  114  et  seq. 

Hypochondriasis  67 

I. 
Impotency 39,  67,  71,  78,  109,  146,  147,  163  et  seq. 

Imaginary  170 

Indigestion 160,  161 

Infiltration  of  gland   50,  75,  77,  81,  116 

Injections 22,  52,  62,     70 

Insanity 55 

Insomnia 23,  67,  68,  102,  159,  160 

Instrumentation — Sir  Fenwick's  advice 63 

Sir  H.  Thompson's  advice 63 

Instruments — Special  of  author's 53,  54,  106 

Size  of  61 

Instrumentation— Faulty   21,  36,  63,  78,  120 

Avoid  during  acute  stage 22 

Frequency  of  use 61,     62 

Intercourse — Excessive  35,  71,     78 

Iodide  of  potassium  in  syphilitic  prostatitis 141 

K. 

Keersmaecker — On  chronic  urethritis 40 

On  gonococci   28 

L. 

Lascivious  readings    38 

Latent  gonococci 29,  30,  31,  32,  77,  81,  150 

Libidinous  thoughts 34,  38 

Lindeman's  theory  on  gonococcal  metastasis 29 

Littre's  glands   27 

Liver — Disorder  of = 89 

Relation  to  prostate 89 

M. 

Maltreatment — As  cause  of  prostatitis 29 

As  cause  of  urethritis 41 

Mania 156,  157,  159 


Ti  INDEX. 

Marriage — After  gonorrhea   150 

Married   Men — Treatment  of 38 

Massage 109,  112,  115 

Masturbation 19,  35,  69,  71,  102,  172 

111  effects  of 35,  49 

Frequency  of  habit 35,  36 

Symptoms    36 

Melancholia 39,  50,  102,  155,  156,  157,  158,  159,  165 

Melancholic  mania 156 

Mental  depression  39,  50 

Mental  disorders    19,  78,  102 

Caused  by  masturbation 35 

Mercury — In  syphilitic  prostatitis 144 

Metastasis  of  gonorrheal  infection 29,  30,  31,  50,  81 

Mixed  infection 29 

Morning  drop   33,  41 

Morphine    22,  141 

Muscular  spasm — Of  urethra 43,  49 

Of  prostate  80 

N. 

Nerves — Of  prostate  16,  151 

Of  perineum 17 

Of  external  genitalia 18 

Pressure  upon  117 

Nervousness  68,     69 

Neisser's  theory  on  metastasis 29 

Neurasthenia   152,  153,  154 

Neuralgic  pains 29,  31,     81 

Neurotic  aberrations  19 

Neurotic  disturbances,  reflex... 32,  37,  50,  70,  81,  84,  117,  151 

Neuroses  of  prostate 152 

Nitrate  of  silver — Improper  use  of 58 

0. 

Opiates 1,  22,  141 

Orchitis   22,  23,  143 

Orchidectomy — For  hypertrophy    121,  125 

Orgasm— Seat  of   14,  19 

Otis— On  gleet 39 

P. 

Pains  from  metastasis 29,  30,  31,  32 

Paraparesis    112,  171 


INDEX.  vii 

Paresis  50,  78,  171 

Paraplegia  145,  146,  155,  172 

Phagocytosis — Action  on  cocci ^ 31,     58 

Phimosis   70 

As  cause  of  masturbation 36 

Pollutions   164,  170,  171 

Polypoid  growths 80,  85,  106,  130,  135,  143 

Potassium  iodide 138 

Potentia  coeundi   166 

Potentia  generandi 166 

Priapism,  chronic 38,  51,  147,  158 

Premature  ejection 48,     67 

Prostate — Anatomy  of 11 

Compared  to  uterus 75,  116 

Relation   to   cerebro-spinal    centers 37 

Relation  to  viscera 11,  84,     88 

Prostatectomy 121 

Dangers    of    123 

Prostatitis   21 

Acute  21,     30 

Classification    21 

Chronic 22,36,37,     64 

Congested  enlargement 75,  77,  108,  115  et  seq. 

Frequency    11 

Senile  hypertrophy   24,  75,  77,  114  et  seq. 

Suh-acute    24,     34 

Syphilitic 143 

Tubercular    144 

(See  Treatment.) 

Prostatic    expressions    29,     32 

Prostatorrhea 80,  166,  167 

Ptomaine  poisoning  from  gonococci 29,     81 

Pus — In  discharge 67,     80 

In  urethra 6° 

In  urine '. 84,  85,  107,  137,  140 

R. 

Rectum— Relation  to  prostate 11,  12,     51 

Rheumatism 26,  29,  30,  31,  32,     81 

S. 


Sciatica 


163 


Sciatic  nerve  18>  50,     81 


viii  INDEX. 

Sciatic   nerve — Irritation  of 161,  162 

Secretions — Action  on  gonococci 32 

Of  glands  of  Littre 167 

Of  Cowper's  glands 167 

Prostatic 16,  19,  29,  167 

Semen — Expulsion  of 18,  50 

Over-accumulation   of    89,  91 

Seminal    discharges — Classification   of 164 

Seminal  vesicles   16,  89 

Relation  to  prostate 91 

Stripping  of  29 

Sexual   appetite    19 

Erratic    67 

Excessive  78,  158 

Sexual  brain 19,  164 

Sexual   indulgence,   excessive    35,  71,  78 

As  compared  to  masturbation 35 

Sexual  perversion    112 

Shreds  in  urine   168 

Desiccated  discharge   50,  85 

Removal  of  granulations 61,  65 

Sounds— Injudicious  use  of 64,  79,  104,  105,  109,  112 

Spermatorrhea    67,   80,   163,    165,  167 

Spermatozoa    85,   165,   166,  167 

Stone  in  bladder  86,  111,  120 

Sterility   166,  et  seq. 

Stomach — Nervous  relation  to  prostate 16,  117 

Stricture   39,  40,  49,  64,  66 

Treatment  of    67,  215 

Suppositories,  rectal    2^,  73,  96,  105,  110 

Surgical  treatment  of  hypertrophy 121  et  seq. 

Sympexia 85,  86,  87,  112,  145 

Syphilis,  as  cause  of  prostatitis   143 


Tenesmus    21,  64,  141,  142 

Testicle    , 24 

Theories  on  metastasis  26,  281,     29 

Thiry's   theory  on   rheumatism    26 

Toxins  of  gonococci  29,  30,  31,  32,     81 

Treatment— Author's    126,   127,  128 

Congested  enlargement 92  to  99 


INDEX.  ix 

Treatment — Author's — Frequency  of   61 

Of   acute    prostatitis    22 

Of  acute  urethritis    22 

Of  gonorrheal     prostatitis   57 

Of  sub-acute  prostatitis    32,   33,    44,   45 

Of  stricture   67 

Per  rectum 73,  96,  97,  103,  105,  102,  110,  127,  137,  141 

Senile  hypertrophy    120   et  seq. 

Surgical    120   to  125 

Technique  of  electric   59 

Tuberculosis  of  prostate   144 

U. 

Ulcerations    55,   57,    65,     74 

As  cause  of  gleet   24 

Of  rectum   11,  78,  104,  143 

Uremic  toxemia 102 

Ureters   16,     67 

Urethra— Prostatic    12,  27,  31,     51 

Elongation  of    89 

Localized  lesions  within  the   43 

Membranous   16,     49 

Urethroscope,   use  of    44 

Description  of  44 

Urethritis — Caused  by  diplococci   30 

Chronic   39,  40,     41 

Prostatic    ....19,  38,  49,  52,  64,  71,  82,  105,  106,  108,  112 
Treatment  of  acute    22 

Urine — Acrid    condition    of    

43,  51,  80,  81,  99,  100,  104,  107,  110,  137,  140 

Asepsis  of   38,     74 

Blood  in   85,  110,  113 

Conditions  of   83,  84,  85,  91,  100 

Dribbling  of  117 

Pus  in  84,  85,  137,  140 

Shreds  in 50,  61,  65,  85,  168 

V. 

Varicocele    24 

Vaso-motor  contraction — Result  of  current .55,  61 

Veins  of  bladder   16 

Of  prostate       16 

Of   rectum    16 


X  INDEX. 

Verhoogen  on  chronic  urethritis 40 

On  gonococci   28 

Vesiculitis  22,  44,  50,  71,  72,  82,  104,  112,  113 

Treatment  of    97 

W. 

Wet  feet — Effect  upon  prostatic   disease 36,  109 

Wines — Cause  of  prostatitis    38,  77 

Prohibited    94 

Y. 

Young's  theory  on  gonococci  metastasis ■ . . .  29 

Z. 

Zinc   sulpho    carbolate — In    acute    urethritis 23 

In  prostatic  urethritis    53,   65,  135 


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